Inspection on 09/02/06 for Denville Hall

This inspection was carried out on 9th February 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Denville Hall 02/11/09

Denville Hall 11/11/08

Denville Hall 25/07/06

Denville Hall 12/09/05

Denville Hall 01/03/05

Denville Hall 16/08/04

Denville Hall 02/02/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Denville Hall 62 Ducks Hill Road Northwood Middlesex HA6 2SB Lead Inspector Mrs Clare Henderson Roe Unannounced Inspection 09/02/06 10:00 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 Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 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. Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Denville Hall Address 62 Ducks Hill Road Northwood Middlesex HA6 2SB 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) 01923 825 843 01923 841 855 DENVILLE HALL (REG CHARITY NO. 209480) Mrs Moira Bridget Miller Care Home 40 Category(ies) of Dementia (15), Old age, not falling within any registration, with number other category (0), Physical disability (0), of places Physical disability over 65 years of age (0), Terminally ill (3) Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service Users must be over the age of 59 years. To comply with the Minimum Staffing Notice required by the previous regulator as 31st March 2002. One named service user under the age of 59 years can be accommodated at the home for a two week stay from 22nd November 2005 as agreed by the Commission For Social Care Inspection on 1st December 2005. The home must inform the CSCI when the service user no longer resides at the home. 12th September 2005 Date of last inspection Brief Description of the Service: Denville Hall is a large Victorian detached house, set in spacious grounds. The home provides both nursing and personal care for actors and people of affiliated professions and of pensionable age. The home offers permanent and respite accommodation. In recent years the home has been completely refurbished and a new dementia care wing has been built. The bedrooms are spacious and individually designed, each with an en suite comprising of shower, toilet and wash hand basin facilities. There are several communal rooms, providing a variety of usages, to include a library, drawing room, theatre room, green room, games room, relaxation room, art & crafts room, hairdressing salon, two dining rooms, two bar facilities, several sitting rooms of varying sizes plus conservatory and courtyard areas. The extensive external grounds are landscaped and well maintained, with a selection of seating areas. The home is situated within a short drive of Northwood town centre, where there are shops and restaurants, plus public transport links in the form of bus and underground services. Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 12 hours were spent on the inspection process. The Inspector carried out a tour of the home, and inspected service user plans, staff records, maintenance and servicing records. 5 service users and 4 staff were spoken with as part of the inspection process. A CSCI Pharmacist Inspector inspected the medication management. The purpose of this inspection was to follow up the requirements and recommendations from the last inspection, and to view some additional standards. The majority of key standards were viewed at the last inspection and it is recommended that this report be read in conjunction with the last report to gain full inspection information for the home. There were 29 service users accommodated at the time of inspection. What the service does well: What has improved since the last inspection? What they could do better: Staff have undergone mandatory training for health & safety, but the Registered Manager has experienced problems introducing recognised induction, foundation and NVQ in care training. Some shortfalls with the staff employment records were identified. The maintenance in the home is generally kept up to date, but action is to be taken to ensure the emergency lighting is Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 Page 6 serviced annually. Safe working practice risk assessments to include the fire risk assessment require updating. The pre-admission assessment documentation still requires updating in line with Standard 3.3 to ensure all relevant information is ascertained at when prospective service users are assessed. Shortfalls in completion and updates of bedrail and falls risk assessments were noted. The ongoing shortfalls in the management of medications gave the Inspectors cause for concern, and a significant number of requirements in these areas were found to be outstanding from the last inspection report. The importance of working to meet the requirements within the timescales set, and to keep the CSCI informed should it not be possible to meet the timescale, was discussed with the Registered Manager. Whilst it is accepted that several of the service users accommodated are still quite independent in many areas of their care, the home is a Registered Care Home, and as such must ensure that it abides by the National Minimum Standards for Older People and the Care Homes Regulations 2001. Action must be taken to address the requirements in this report in a robust and effective manner, and ongoing auditing processes should be in place to maintain the improvements once made. 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. Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 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 Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 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. The home does not provide intermediate care. The pre-admission assessment document is not comprehensive, so the home struggles at times to get clear, accurate information regarding prospective service users. EVIDENCE: The home has a pre-admission assessment document. This still needs to be reviewed in line with Standard 3.3 to ensure comprehensive information is requested. Whilst it is understood that the home draws referrals nationwide and sometimes further afield, the provision of a clear, accurate and comprehensive pre-admission assessment will assist with the process to ensure that the home can meet the service users assessed needs. Many of the service users attend the home for respite care on several occasions prior to permanently residing at the home, and in these cases it is possible for the home to build up a good picture of the service users needs. For a service user on the dementia care unit, pre-admission nursing and medical assessments had been obtained. Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 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 Service user plans did not always accurately reflect the condition and needs of the service user. Shortfalls in the medication management could place service users at risk. Staff are courteous to service users and personal support is provided in such a way as to promote and protect the service users privacy and dignity. EVIDENCE: Two service user plans were viewed for the general care unit. The service user plans provide an overall view of the service users needs. A document listing the areas of care is completed for each service user. Where a problem had been identified, a care plan had not always been formulated to address this need. Documentation had not always been signed and/or dated. On the dementia care unit, the service user plan viewed was well completed, with care plans formulated for each identified need. Dementia care needs had been clearly incorporated into the care plans. Risk assessments for falls had been formulated, but had not always been updated following a fall. This is a repeat finding from the last inspection. Risk assessments for other areas of risk identified had been formulated, with the exception of those for service users who drive (see Standard 38) and for the majority of service users who are selfmedicating. These areas were discussed at the time of inspection. Evidence of Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 Page 10 the involvement of service users and/or their representatives in the formulation and review of the service user plans was not seen. Documentation for wound care is in place and was up to date. The specific pressure relieving equipment in place had been identified in the service user plan viewed, and was seen in use in the home. Pressure sore risk assessments and moving & handling assessments are in place. The registered nurses are working on documentation for a nutritional assessment and a continence assessment. These need to be completed and put into use. On the dementia care unit, a clear assessment in respect of the suitability of the use of bedrails had been carried out. On the general care unit the use of bedrails is identified, but there is no clear assessment carried out to identify the reason for their use, any risks identified and the appropriateness of using bedrails for the individual. This is a repeat finding from the last inspection. There was evidence of input from health care professionals, and this is recorded in each service user plan. The CSCI Pharmacist Inspector carried out a full medications inspection on 09/02/06 and a separate inspection report is available. The requirements and recommendations resulting from that inspection have been incorporated into this report. The abbreviation ‘MAR’ stands for Medication Administration Record. Ongoing shortfalls with the management of medications gave the Inspectors cause for concern and action must be taken to address this area robustly and effectively. Staff were seen to speak with service users in a courteous and respectful manner. Service users spoken with said that they are well cared for and enjoy living at the home. Staff speak with service users using their preferred term of address. Bedrooms viewed were personalised and had a very homely feel to them. There is a contented atmosphere throughout the home. Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 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): 14, 15 and aspects of 12. Service users are encouraged to exercise their independence wherever they are able, to maintain their quality of life. The food provision is good and varied, and mealtimes are well managed, thus ensuring service users nutritional needs are met. EVIDENCE: On the day of inspection a theatre trip to the West End had been planned. The home continues to provide a good variety of activities to meet the service users interests and needs, for both the general care and the dementia care units. Service users are encouraged to go out to events whenever they are able to do so. Where service users are unable to manage their own finances, their representative carries this role. The home has access to Age Concern advocacy services, and also to the Actors Charitable Trust Welfare Committee who can provide help and advice for service users. Service users are encouraged to maintain their independence for as long as they are able, and are supported in this. The Inspectors sampled the luncheon meal. This was well presented and tasty, with both the meat and vegetarian options being sampled. Menus are provided for service users, who make their choices in advance of the meal. It was clear Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 Page 12 that should a service user decide to opt for a different choice at the mealtime, this is catered for. Service users were seen enjoying their meals, and visitors were also present. Staff serving the meal did so in an efficient and courteous manner. Fresh flowers were decorating each table. The kitchen was viewed and was clean and tidy. Risk assessments for equipment and safe working practices are in place, and the chef explained that the catering contractors had just issued new health & safety documentation and staff would receive training in the completion of this. Kitchen documentation to include fridge, freezer and food temperature records were up to date. The food stores were well stocked with evidence of good stock rotation. Staff have access to the kitchen and food stores 24 hours a day. Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 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): None EVIDENCE: These standards were assessed at the last inspection. There have been no complaints or adult protection cases since the last inspection. Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 Page 14 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): 26 Procedures for infection control are in place, thus safeguarding service users. EVIDENCE: The home continues to provide high standard accommodation for the service users. The home was clean and smelled fresh throughout. Bathroom areas viewed were clean and tidy and no toiletries were seen in communal areas. This standard was viewed in depth at the last inspection. Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 Page 15 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 The home is appropriately staffed to meet the needs of the service users. The arrangements for induction, foundation and NVQ training in care are not in place and staff are potentially therefore not being kept up to date with best practice. Recruitment procedures are overall in place, with some shortfalls to be addressed to ensure procedures are fully robust and thus safeguarding service users. EVIDENCE: The home is appropriately staffed to meet the needs of the service users. The Registered Manager keeps the staffing under review to ensure that staff are available to assist service users with all their needs to include outings. Training records are available for staff. At the previous inspection a new package of induction, foundation and NVQ training had been purchased for introduction. The Registered Manager reported that the package was no longer accessible and that she is making enquiries with the Learning Skills Council in respect of NVQ in care training for staff. One member of the care staff has an NVQ in care level 2. The need for induction, foundation and NVQ training to be in place and ongoing in the home was discussed. Two sets of staff employment records were viewed. Application forms, medical information, two references, Criminal Records Bureau check confirmations and evidence of identity were available. A recent photograph of each member of staff had still not been obtained. The Registered Manager said that the terms & conditions and contracts are still under review. Some information regarding Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 Page 16 permission to work was to be ascertained, and the Registered Manager has since confirmed that this has been addressed. The reasons for leaving previous employment are not asked on the application form. The Registered Manager said that this would be easy to address. Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 Page 17 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, 36 and 38 The Registered Manager is experienced to manage the home. The systems for quality assurance need to be documented to evidence service user consultation and ongoing auditing within the home. Staff supervision arrangements should be reviewed to encompass career development and review of practice. The health and safety management in the home is generally good, with some areas to be reviewed to ensure that the health & safety of service users, staff and visitors is robustly managed in all areas. EVIDENCE: The Registered Manager has announced her intention to retire in the next few months. She is aware of the need for her successor to have the appropriate qualifications and experience to take on the Managers role. Once appointed, a new Manager would go through the process of registration with the CSCI. The Registered Manager has developed satisfaction surveys to be sent out to service users. Once collated, a copy of the results of the survey is to be Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 Page 18 forwarded to the CSCI. Regulation 26 visit reports are now being received monthly by the CSCI. The Registered Manager said that she had not yet completed an annual development programme for quality assurance, which was a requirement from the last inspection. The home does not have a system of recorded, formal supervision. The Registered Manager and registered nurses explained that supervision for all staff takes place on a day-to-day basis at handover, and any issues are discussed and a record kept. The system for formal supervision was discussed, and it was felt that this is not something required by the staff. However, this needs to be reviewed to provide the staff with the opportunity to discuss any aspects of their work plus career development needs on an individual basis. The inspector viewed some of the maintenance and servicing records at random. These were up to date with the exception of the emergency lighting servicing checks. There was evidence of in-house checks being carried out, and the Registered Manager said that she would make further enquiries to get the annual servicing of the emergency lighting system in place. Risk assessments for equipment and safe working practices are in place, some of which were updated in 2005. The Registered Manager said that these would be updated. In addition to those already in place, a risk assessment for service users who are drivers needs to be formulated. The fire risk assessment was out of date and the Registered Manager said that this would be updated. Staff have undergone mandatory training, with further sessions in moving & handling booked during the next month. Ongoing training in health & safety related topics is planned. Accidents are recorded and there was evidence of accident forms being completed. The reporting of all incidents as listed under Regulation 37 of the Care Homes Regulations 2001 in line with issued guidance was discussed, as a relevant incident had not been reported to CSCI. Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 Page 19 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 X 2 Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 Requirement The pre-admission assessment documentation must be reviewed in line with Standard 3.3 of the National Minimum Standards for Older People. (previous timescale of 01/11/05 not met) Pre-admission assessments must be carried out for prospective service users, unless an up to date Social Services or equivalent assessment is obtained. Risk assessments for falls must be updated following any falls. (previous timescale of 01/10/05 not met) Care plans must be formulated to address all the service users identified needs. Where a need is identified, assessments for continence and for nutritional needs must be carried out (previous timescale of 21/10/05 not met). The documentation for these assessments must be completed and put into use. Following the completion of the bedrail risk assessment, the DS0000010929.V279340.R01.S.doc Timescale for action 01/04/06 2. OP7 13(4) 01/03/06 3. 4. OP7 OP8 7(1)(a) 17(1)(a) 01/04/06 01/04/06 5. OP8 13(7) 01/03/06 Denville Hall Version 5.1 Page 21 6. OP9 13(2) 7. OP9 13(2) 8. 9. OP9 OP9 13(2) 13(2) 10. OP9 13(2) 11. OP9 13(2) 12. OP9 13(2) 13. 14. OP9 OP29 13(2) 19 Sch 2 appropriateness of and reason for the use of bedrails must be clearly recorded. (previous timescale of 21/10/05 not met) Fridge temperatures must be maintained between 2 and 8 degrees centigrade. (previous timescale of 21/10/05 not met) Medication kept by service users who are self-medicating must be stored securely. (previous timescale of 21/10/05 not met) A record must be kept of current medication for all service users who are self-medicating. That the home updates it medicines policy and homely remedies policy. (previous timescale of 21/10/05 not met). The errors policy must include a reference to reporting untoward incidents to CSCI. That the home has risk assessments in place for all service users who are self medicating and that these are regularly updated according to the needs of the service user. (previous timescale of 21/10/05 not met) All medicines must be recorded accurately when administered, including variable doses. If not administered then the correct endorsement must be used. (previous timescale of 01/10/05 not met) Different strengths of tablets must be recorded separately on the MAR. (previous timescale of 01/10/05 not met) There must be a list of specimen signatures and initials of those staff administering medication Staff employment files must DS0000010929.V279340.R01.S.doc 01/03/06 01/03/06 01/03/06 01/05/06 01/04/06 14/02/06 14/02/06 21/10/05 01/03/06 Page 22 Denville Hall Version 5.1 15. OP30 18 16. OP33 24 17. OP38 23(4) 18. OP38 13(4) 19. OP38 23(4) 20. OP38 37 contain a recent photograph for each employee. (previous timescale of 21/10/05 not met). The application form must be reviewed to ensure that the reason for leaving all previous employments is obtained. All documentation required under Schedule 2 of the Care Homes Regulations 2001 must be in place for each employee. The induction, foundation and NVQ in care training must be commenced and evidence to show staff progress be maintained in the home. (previous timescale of 01/11/05 not met). An action plan to show how this is to be addressed must be forwarded to the CSCI by 01/04/06, with training commenced by 01/06/06. A development plan to reflect the monitoring processes in place in the home for quality assurance must be developed. A copy must be forwarded to the CSCI. (previous timescale of 01/11/05 not met) The emergency lighting system must be serviced promptly and thereafter an annual basis. Evidence that this has been carried out must be forwarded to the CSCI. Risk assessments for equipment and safe working practices must be reviewed annually and whenever there is a relevant change. A risk assessment for service users who are drivers must be in place. The fire risk assessment must be updated promptly and thereafter reviewed annually and whenever there is a relevant change. All accidents and incidents must DS0000010929.V279340.R01.S.doc 01/06/06 01/05/06 01/04/06 01/04/06 01/03/06 24/02/06 Page 23 Denville Hall Version 5.1 be reported to the CSCI in line with the Regulation 37 guidance issued by the NCSC. 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. 4. 5. 6. Refer to Standard OP7 OP7 OP9 OP9 OP9 OP36 Good Practice Recommendations A system for recording and evidencing input from service users and/or their representatives in the formulation and review of the service users plans should be introduced. Staff completing the service user plans should ensure that all entries are signed and dated, in line with Nursing & Midwifery Council records and record keeping guidelines. That the pulse for service users on digoxin is documented on the MAR. That the home /GP and pharmacist consider a bulk prescription for items such as lactulose. That a separate record of waste medicines is kept by the home. It is strongly recommended that supervision arrangements be reviewed to offer all staff providing care the opportunity for individual supervision sessions, to be carried out in line with Standard 36. Denville Hall DS0000010929.V279340.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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