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Inspection on 27/02/06 for Elderholme Nursing Home

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

This inspection was carried out on 27th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

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

NHS and other health professionals are actively involved in the care of patients as required. Residents spoken to by the inspector said that they were well cared for and that they were able to spend their day as they wished. The standard of food served at Elderholme is good with a strong emphasis on home cooking.

What has improved since the last inspection?

The appointment of an activities co-ordinator has improved the range of recreational activities that are available. The recruitment process has improved significantly, albeit, not all the required documents are in place but the new general manager is addressing this.

What the care home could do better:

There is an urgent need to improve the standard of record keeping in relation to care records and associated documents, which have deteriorated. The system for ordering, receipt, storage and administration of medications also need to be addressed urgently.

CARE HOMES FOR OLDER PEOPLE Elderholme Nursing Home Clatterbridge Road Bebington Wirral CH63 4JY Lead Inspector Les Smith Unannounced Inspection 27th February 2006 08:30 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 Elderholme Nursing Home DS0000020938.V286394.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. Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Elderholme Nursing Home Address Clatterbridge Road Bebington Wirral CH63 4JY 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) 0151 334 0200 0151 343 1312 Wirrelderly Mrs Sandra Edge Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 60 beds nursing care 6 named adults under 65 years of age Date of last inspection 27 September 2005 Brief Description of the Service: Elderholme is situated within the grounds of Clatterbridge Hospital, Wirral. It is a single storey purpose built care home for elderly people, offering both nursing and personal care. The home has recently been extended and now has a capacity for 60 residents. Elderholme has a large dining room and 4 separate lounges, each with a conservatory overlooking the pleasant courtyard. There is good parking to the front of the home and gardens are well kept providing a pleasant outlook from rooms. The home is accessible by public transport, which is routed through the hospital grounds. Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over two days, the second of which involved two inspectors one of whom was a specialist pharmacy inspector. All aspects of the home were inspected including bedrooms, communal areas, laundry and kitchen. Individual care records and associated documents were examined as well as corporate documents. The inspector spoke to residents, visitors and members of staff. The home has a friendly welcoming ambience and staff members were observed to have a good rapport with both residents and their visitors. Relatives and residents spoken to during the course of this inspection told the inspector that they were happy with the care and that the staff members were all nice and approachable and that nothing was too much trouble. What the service does well: What has improved since the last inspection? What they could do better: There is an urgent need to improve the standard of record keeping in relation to care records and associated documents, which have deteriorated. The system for ordering, receipt, storage and administration of medications also need to be addressed urgently. Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 6 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. Elderholme Nursing Home DS0000020938.V286394.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 Elderholme Nursing Home DS0000020938.V286394.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): 1,2,3,4 Prospective residents have adequate information to allow them to make an informed decision in relation to accepting a place but cannot be confident that the home will meet their needs. EVIDENCE: The statement of Purpose and Service User Guide had not been updated to reflect the new organisational structure and recent changes within the home. All residents’ files examined had an appropriate Statement of Terms and Conditions or contract in place. Pre-admission assessments were seen for all but one recent admission, which could not be found. The assessments were inadequate in that they did not provide sufficient information for an initial care plan to be constructed and some areas had been left blank. Where specific needs had been identified there was no indication of actions to be taken to meet those needs. Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 9 Care plans were found to be out of date not having been reviewed for varying periods up to six months, incomplete or not present at all. Risk assessments were also found to be either missing or out of date. A large number of documents had no name of resident signature of nurse or date. One care file examined was for a resident admitted on 11th February 2006. A letter was in the file from her daughter giving details of problems, which included severe rheumatoid arthritis, multiple orthopaedic problems, hiatus hernia and irritable bowel symptoms, deafness, bilateral cataracts and macular degenerative disease, short term memory loss, TIAs’, pressure sores and dental problems. At the time of this inspection on 27th February 16 days after admission, the personal bibliography had not been completed in full and there were no risk assessments or care plan in place. The inspector asked a member of trained staff how she would establish her needs if she did not know the resident and was told ‘I would ask her’. On the day of inspection the inspector observed a new resident being admitted and on arrival at the home by ambulance neither the manager nor any other member of staff were expecting the admission with the consequence that no room had been prepared. Enquiries demonstrated that there were no details in the TCI book or the diary. Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 A lack of care planning, risk assessment and review places residents at risk of harm or injury. EVIDENCE: Care files were examined for a selection of recent and established residents. Details of the inspectors’ findings are detailed below: Resident A A care plan was in place but was out of date. No care plan reviews had been carried out since 14th November 2005. Catheter records showed a last change in September 2005 and the inspector was informed that the catheter was no longer in place but when it had been removed was not recorded. Pressure sores were being treated but there were no appropriate wound records in place and there were no specific pressure relieving directions in the care plan. The tissue viability nurse specialist had seen the resident. A Waterlow score had been recorded but was clearly inaccurate given the changes that had occurred since the last review. Risk assessments were in place for Manual Handling and Falls. There were no assessments in place for continence or nutrition both of Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 11 which are essential were skin integrity is compromised, particularly when, as in this situation the resident was doubly incontinent. Bed rails were in situ and a risk assessment had been done but there was no authorisation from the resident or their representative. Resident B Care plan was in place but had not been reviewed since July 2005. Bed rails were in situ without a signed authorisation. Risk assessments were in place but had not been reviewed since April 2005 and there had clearly been significant changes since. There were no appropriate wound records in place. The resident had been identified as being overweight but there no records of routine regular observations of blood pressure or weight. Resident C Admitted in 2006. A care plan had been started on 2nd February but included continence, hygiene and mobility only. The resident had been identified as diabetic but there was no care plan to manage the condition. There were no risk assessments in place except for bed rails for which there was no signed authorisation. No weights had been recorded. Resident D Admitted in 2006. At the time of inspection there were no risk assessments or any care planning in place. It is a serious concern that on the second day of this inspection there were still no risk assessments or care planning in place some three weeks after admission and one week after the first inspection day when an immediate requirement had been issued. Resident E Admitted in 2006. At the time of inspection there were no risk assessments or any care planning in place. Full facts are detailed under standard 4. Daily diary sheets were completed in variable amounts of detail. Some members of staff record a good level of detail whilst others record non-specific comments such as “settled and slept well”, “satisfactory morning”, appears bright”, and “no change”. Statements such as these give no indication as to the actual care delivered, the result of that care or how the resident has spent their day. Associated documentation such as fluid charts is poorly maintained and does not demonstrate the level of care given. In one file examined the specialist peg feed nurse on a review in September 2005 had commented on the lack of accurate fluid charts and requested that a more comprehensive record be kept. It was evident that in this particular case the directions for additional fluids via Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 12 the peg tube were not being adhered to. Lack of entries, inappropriate entries, totals, dates and even names on the charts were evident on the majority of charts is use. Medication findings Medication administration records (Mar sheets) were examined for all residents, with the findings as follows: Gaps on MAR sheets Colour photographic identification for most residents. Handwritten transcriptions signed with one signature, others no signature. Labels on Mars placed over previous prescriptions Excessive stocks Incomplete handwritten prescriptions e.g. no dose or frequency Out of date medication policy (October 2003), not taking into account recent changes in medication management, especially regarding returns. No room temperature records being kept (only fridge temperatures seen) Resident self-medicating without any risk assessment or appropriate documentation Concerns in relation to medication were such that a second inspection day was scheduled with a specialist pharmacy inspector whose detailed findings will be in a separate report. A number of residents and relatives were spoken to during the inspection and all confirmed that privacy and dignity are respected. The inspector also directly observed that staff members were courteous and polite to residents and that personal care was always carried out in private. Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 As far as possible residents have choice and flexibility in how they spend their day in the home, and pursue social and recreational activities according to their choice and preferences thereby promoting independence and individuality for each resident. Meals at Elderholme are good, offering choice and variety whilst catering for residents dietary needs or cultural preferences EVIDENCE: The home has recently appointed an activities co-ordinator and the range of activities now available has increased. On the day of inspection the residents were playing Bingo and the inspector observed the co-ordinator playing chess with one resident in their room. Activities also include trips out in the homes mini-bus to local attractions. The inspector was informed that the activities coordinator is currently part-time and it is planned to increase the hours to 20 per week. However in view of the size of the home and the number of residents that would benefit from one to one activities it is recommended that consideration be given to increasing the hours of the activities co-ordinator to full-time and that more be done to provide stimulus for those who cannot participate in group activities. Whilst the activities co-ordinator keeps records Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 14 of activities it is strongly recommended that activities be recorded in the daily diary sheets. Access to the courtyard is via the conservatory and together with the well cared for gardens provides an opportunity for fresh air in good weather and these facilities are appreciated by the residents. The home has a policy of open visiting with friends and family welcome at any reasonable time and to stay as long as they and the resident wished. The inspector observed visitors in the home throughout the day. Residents spoken to told the inspector that personal choice was encouraged in many aspects of the daily routines which are kept as flexible as possible. Dietary needs are well met both in terms of quantity and quality. The inspector observed fresh bread rolls being prepared and meals seen were well presented with staff members available to assist in a sensitive and discrete way if required. Menus seen demonstrated a good variety with alternative choices being available. Members of the catering staff have valid food hygiene and handling certificates. Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 An efficient complaint and adult protection policy and procedure was in place to help ensure the safety and welfare of residents. EVIDENCE: Elderholme has an efficient complaint and adult protection policy and procedure in place to help ensure the safety and welfare of residents that patients, relatives and staff can access when necessary. This procedure includes information on ‘whistle-blowing’, in accordance with the Department of Health ‘No Secrets’ guidelines. The CSCI has not received any complaints about this service since the previous inspection. Most of the staff have, or are in process of completing training in adult protection, with the remaining having training planned for the near future. However all staff do receive basic information in the protection of vulnerable adults during induction. The residents all spoke highly of the staff team and said they “have no complaints about how I’m treated”, and “nothing is too much trouble”. Independent advocacy information was available if required by residents or their relatives. Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 16 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): 19,20,21,22,23,24,25,26 The standard of the environment at Elderholme is good providing a homely and comfortable place to live but lack of management has compromised safety in some areas. EVIDENCE: The inspector undertook a tour of the home accompanied by the registered manager. The observations made are detailed as follows: The older part of the home is starting to look tired in relation to décor and the inspector was informed that now the new extension has been completed this part of the home is scheduled for redecoration. A worktop in the dining room had trim missing, which prohibits effective cleaning and needs replacement. Most of the bathrooms had multiple toiletries in place Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 17 Trolleys in two bathrooms were dirty and needed thorough cleaning A large number of beds had only one bed rail fitted with the wall being used as the other rail. This is not acceptable and the residents who have only one bed rail in fitted must have two fitted to the bed. Several sets of bed rails were observed to be of the old design but there was no evidence that the gaps between bars had been checked and that these rails were suitable for use. A number of beds were also seen with bed rails fitted but no protective bumpers in situ. The risks associated with using bed rails without protective bumpers cannot be over-estimated and bumpers must always be fitted. The designated competent person must keep records to evidence regular safety checks on all bed-rails in use. A can of thick and easy thickener was seen to be in general use that belonged to a previous resident. Communal areas seen were well furnished with comfortable chairs and well used by residents. The use of paper continence sheets on the chairs does little for residents’ welfare and it is strongly recommended that more appropriate methods of protecting chairs from incontinence be explored. The laundry was clean and tidy with relevant COSHH documents available for the staff. The environmental health inspector inspected the kitchen in July 2005 and requirements made at that time had not been met in full. Temperatures of the refrigerators and freezers are always recorded and a cleaning schedule was not available for the inspector to see. The wood used to cover the unused hob was badly burnt and damaged. There are sufficient numbers of toilets and washing facilities available for the residents use and facilities are close to the communal areas. The independence of residents is promoted by a large variety of aids including grab rails; assisted baths, raised toilet seats and residents who require them have wheelchairs. Residents’ rooms are well furnished, bright and spacious with many rooms personalised by residents’ with personal possessions and memorabilia. The practice of storing items on the top of wardrobes is contrary to Health and Safety guidelines and must be discouraged due to the risks created. It is strongly recommended that alternative safe storage facilities be sought. The inspector observed several residents’ being moved in wheelchairs without footrests or lap belts used. This practice is not in accordance with good practice guidelines and is not acceptable. Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 18 On both days of the inspection the home presented as being clean and hygienic. Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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): 27,28,29,30 Staff members are recruited via satisfactory procedures and deployed in sufficient numbers and skill mix to meet the residents’ needs. EVIDENCE: Levels for both trained and untrained members of staff are sufficient to meet residents’ needs at all times. A selection of staff personnel files were examined and found to contain most of the required documents in place. The inspector was informed that those without photographic ID would be having their photograph taken in the coming week. Two references and Criminal Record checks or Pova First clearances were seen for all files examined. The home has eight members of staff with NVQ2 and six with NVQ3 and there are a further eight members of staff working towards NVQ2. All staff members have completed their mandatory training for fire prevention and manual handling. Training has also been carried out in abuse, infection control and first aid. There is a qualified first aider on duty on every shift. There is a need to improve the induction process for new staff and the inspector was informed that the home is obtaining a commercially produced Induction to Care programme, which will be put into place in the very near future. Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 20 The home also needs to consider providing additional specialist training in areas such as diabetes, Stroke care, tissue viability and dementia to help promote an awareness and competence in these specialised fields. Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 21 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): 31,32,33,36,37,38 There is no effective care management at this home due to lack of leadership, guidance and supervision, which compromises the health, safety, and welfare of residents and staff. EVIDENCE: The registered manager is a first level nurse who has managed the home for the last five years and is registered with the CSCI. There have been recent changes in the organisational structure of the home with the management of catering, domestic and administrative responsibilities being passed to the newly appointed general manager and progress is being made in these areas. As detailed in earlier sections of this report there are serious deficiencies in the nurse management of residents’ care records including pre-admission Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 22 assessments, care planning, risk assessments and associated documents and aspects of medication receipt, storage and administration all of which have seen a deterioration over the last six months. On being asked why the records were so poor the manager told the inspector that she had been complacent and that she had trusted her staff. There is no comprehensive quality assurance system in place at the home although the home holds the ‘Investors in People’ award and is due for a reassessment in the near future. There is no formal supervision of care staff in place. The manager requested clarification from the inspector as to what formal supervision meant. Records are securely stored and held in accordance with the Data Protection Act but are not up to date. Appropriate service and safety certificates were seen for the fire alarm system, fire extinguishers, emergency lighting and relevant regular testing was seen in the fire logbook. The service certificates were seen for hoists but were not available for the assisted baths current certificates having expired in September 2005. It is understood that the company that used to do this work has gone into liquidation and a replacement company is being sought. The gas safety certificate was not available and it is understood that one will not be issued until the cooking ranges have been replaced due to their failure to meet current regulations. Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 23 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 2 3 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 2 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X 1 2 2 Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 24 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 OP1 Regulation 4(1) Requirement The registered person must ensure that the homes Statement of Purpose and Service Users Guide are updated to reflect the current organisational structure and include all the elements in schedule 1 The registered person must ensure new service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. The registered person must ensure that the care home can evidence the homes capacity to meet the assessed needs (incl. specialist needs) of residents admitted to the home The registered person must ensure a service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides DS0000020938.V286394.R01.S.doc Timescale for action 31/05/06 2 OP3 14(1) 31/05/06 3 OP4 14 & 15 30/06/06 4 OP7 15(1) 30/06/06 Elderholme Nursing Home Version 5.1 Page 25 5 OP7 15(2)(b) 6 OP8 13(1) the basis for the care to be delivered. The registered person must 30/06/06 ensure that the residents’ care plan is kept under review and the resident is kept informed of any such revisions The registered person must 30/06/06 promote and maintain service users’ health and ensures access to health care services to meet assessed needs. Evidence of this must be maintained. The registered person must ensure that medication policies and procedures be reviewed in line with Royal Pharmaceutical Society of Great Britain and Nursing & Midwifery Council guidelines to cover all aspects of medicines management. The registered person must ensure that self-medication is promoted where appropriate. Risk assessments must be completed (and reviewed) and the resident provided with secure storage facilities within their private room. The registered person must ensure that full and accurate records are kept of all medicines received, administered and leaving the care of the home. There must be a full record of all medication currently prescribed for each resident. The registered person must ensure that all medication is only administered in accordance with the General Practitioners instructions The registered person must ensure that medicines are only DS0000020938.V286394.R01.S.doc 7 OP9 13(2) 30/04/06 8 OP9 13(2) 31/03/06 9 OP9 13(2) Sch 3 (i) 17/03/06 10 OP9 13(2) 17/03/06 11 OP9 13(2) 17/03/06 Elderholme Nursing Home Version 5.1 Page 26 administered to the resident for whom they were prescribed. There must be no sharing of prescribed preparations. 12 OP9 13(2) Sch 3 (i) The registered person must ensure that there is a detailed protocol and procedure in place for the administration of medication via the PEG tube. Written authorisation for this practice must be obtained from the residents General Practitioner. Administration must be recorded clearly. The registered person must ensure that staff authorised to administer medication receive accredited medicines management training and have an assessment of their competence, prior to performing these tasks. The registered person must ensure that nurses take and record the residents pulse prior to the administration of Digoxin. The registered person must ensure that medication is stored securely at all times. 17/03/06 13 OP9 13(2) 18(1) 31/03/06 14 OP9 13(2) 13(6) 17/03/06 15 OP9 13(2) 17/03/06 16 OP12 16(2)(m)(n) 17 OP19 23(2)(b) 18 OP22 23(c) The registered person must 31/05/06 ensure that residents’ social and recreational interests are recorded and participation in activities is recorded The registered person is required 30/06/06 to keep the care home well maintained and in good order both internally and externally at all times. The registered person must 31/05/06 ensure that all equipment provided at the care home is suitable for the individual service user, and is checked on a regular basis by a competent person and DS0000020938.V286394.R01.S.doc Version 5.1 Page 27 Elderholme Nursing Home 19 OP24 23(m) 20 OP29 19 21 OP30 18 22 OP31 9 23 OP33 24 24 OP33 26 25 OP36 18(2) 26 OP37 17 27 OP38 13(4)(a) such checks recorded (Refer to bed rails) The registered person must ensure there is adequate storage space for all residents, and must not store heavy items above the current HSE recommended height. The registered person must ensure that the home obtains all the documents and records as listed in schedule 2 The registered person must ensure that all staff receives training appropriate to the work they perform, and accurate records of this are kept. A person shall not manage a care home unless he has the qualifications, skills and experience necessary for managing the care home. The registered person must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care, including nursing at the care home. The registered person must carry out unannounced visits in accordance with this regulation, and provide a copy of the subsequent report to the Commission. The registered person must ensure that persons working at the home are appropriately supervised The registered person must ensure that all records in relation to residents and the home are up to date and available for inspection at all times. The registered person must ensure that all parts of the home to which residents’ have access are so far as reasonably practicable free from hazards to DS0000020938.V286394.R01.S.doc 30/06/06 31/05/06 30/06/06 30/06/06 30/06/06 31/05/06 31/05/06 31/05/06 31/05/06 Elderholme Nursing Home Version 5.1 Page 28 28 OP38 13(4)(c) 29 OP38 23(c) 30 OP38 23(c) their safety (refer to toiletries etc. in bathrooms) The registered person must ensure that unnecessary risks to the health or safety of residents are identified and so far as possible eliminated (refer to environmental health inspection report dated July 2005 and lack of fridge and freezer temperatures) The registered person must ensure that arrangements are made for the regular service of assisted baths and forward copies of relevant certificates to the CSCI The registered person must ensure that the appropriate replacements and remedial work is carried out and a valid gas safety certificate obtained and a copy forwarded to the CSCI 31/05/06 31/05/06 31/05/06 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 Refer to Standard OP9 Good Practice Recommendations Criteria for the administration of when required and variable dose medication should be clearly defined and recorded for all service users prescribed such items. Verbal dose changes and new medication should be accurately entered onto Medication Administration Record charts with staff signature, date and authority where appropriate. Verbal dose changes should be confirmed in writing by the prescriber. Sticky labels supplied by the pharmacy should not be attached to Medication Administration Record charts. A second member of staff should witness all hand written Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 29 annotations on Medication Administration Record charts. 2 OP9 Medicines must be stored at the appropriate temperature. A record of temperature must be maintained for all areas where medicines are kept (fridge should be monitored daily) The opening date should be recorded on eye drops and other items with a short shelf-life 3 OP9 Manufacturers Patient Information Leaflets should be available for medicines in the custody of the home There should be a ‘signature’ list for staff authorised to administer medication 4 OP9 There should be a formal system for prompting medication reviews in line with National Service Framework for Older People Elderholme Nursing Home DS0000020938.V286394.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Liverpool Local Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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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