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Inspection on 01/11/05 for Elizabeth House Care Home

Also see our care home review for Elizabeth House Care Home for more information

This inspection was carried out on 1st November 2005.

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.

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

Service users and their relatives are confident that their complaints will be listened to taken seriously and acted upon and praised all services provided. Policies and procedures are in place to protect service users who are vulnerable, however good practice recommendations have been made to further improve this. Service users health, personal and social care needs are set out in individuals care plans, and service users and relatives feel they are treated with respect and their right to privacy is upheld. One service user reported that the manager was absolutely wonderful and would sort any problems straight away. Service users live in a generally safe, well-maintained environment, which was clean and free from mal-odour. Staffing levels meet the minimum standards for the registration purposes of the home and service users financial interests are safeguarded.

What has improved since the last inspection?

The management of medicines is much improved. There is improvement noted in documentation in care plans and the manager is aware not to admit service users outside of the registration category. Arrangements are in place to further improve and monitor care practices such as manual handling and pressure sore relief.

CARE HOMES FOR OLDER PEOPLE Elizabeth House Care Home 2 Church Hill Avenue Mansfield Woodhouse Mansfield Nottinghamshire NG19 9JT Lead Inspector Jayne Hilton Unannounced Inspection 1st November 2005 09:10 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 Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 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. Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Elizabeth House Care Home Address 2 Church Hill Avenue Mansfield Woodhouse Mansfield Nottinghamshire NG19 9JT 01623 657368 01623 431325 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 Vijay Ramnarain Mr Surenda Dev Lutchia, Mr V Obheegadoo Mrs Vijay Ramnarain Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2005 Brief Description of the Service: Elizabeth House is a care home providing personal care and accommodation for 16 older people. The home is located in Mansfield Woodhouse, in a quiet residential area and close to shops, pubs, the post office and other amenities. The home is an older style domestic property with a more recent two floor extension.There are 14 single, and 1 double berooms, which are located on both floors and there is a passenger lift. There is a variety of lounge areas. There is a garden that is easily accessible for service users. There is limited car parking available on the homes driveway and further parking is available on the street.The manager and at least two staff are on duty throughout the day and night care staff are available throughout the night. Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on 1st November 2005 at 9.10am –1.15pm by Regulation Inspector Jayne Hilton. The focus of the inspection was to assess the requirements set at the previous visit and assessment of the key standards not previously inspected over this inspection year. This report also includes outcomes of an additional visit made to the home on 24th October 2005, by Commission For Social Care Inspection, Pharmacist Inspector Neveeda Knopp. The Commission had also received an anonymous complaint on 23rd August 2005 regarding practices in the home. The inspection methodology incorporated an assessment of some of the identified issues from this complaint. A previous inspection had already included an assessment of other issues raised and therefore were monitored as part of the inspection methodology and requirements set. The methodology included a partial tour of the building, speaking with two service users and a relative, observation of practices, speaking with a practice nurse and three members of staff and the manager. Two care plans were examined briefly, all of the staff files, staffing rota, accident records, policies and procedures, the Statement of Purpose and medicines management in the home. What the service does well: Service users and their relatives are confident that their complaints will be listened to taken seriously and acted upon and praised all services provided. Policies and procedures are in place to protect service users who are vulnerable, however good practice recommendations have been made to further improve this. Service users health, personal and social care needs are set out in individuals care plans, and service users and relatives feel they are treated with respect and their right to privacy is upheld. One service user reported that the manager was absolutely wonderful and would sort any problems straight away. Service users live in a generally safe, well-maintained environment, which was clean and free from mal-odour. Staffing levels meet the minimum standards for the registration purposes of the home and service users financial interests are safeguarded. Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Recruitment practices were assessed as having major shortfalls and an immediate requirement set in relation to this. There is some information missing from staff files also. A statement of purpose provided prospective service users with information about the home, however there are some details, which still require amending or adding to this document to ensure it meets fully with the requirements of the regulation. The needs of service users are not being fully met, because the registered provider/manager has admitted service users that they are not registered to care for and they are waiting for social workers to re-assess their needs. There are still some areas, which need to be improved to ensure the health and welfare of service users is fully maintained. There have been a number of issues to address in relation to the systems in place for medicines management. There are some areas regarding the prevention of cross infection to address. The dependency levels of the service users admitted are high and therefore it is strongly recommended that an extra staff member be employed to account for this. Staff training needs updating regarding manual handling practices and tissue viability and adult protection and staff, need to be appropriately supervised. Please contact the provider for advice of actions taken in response to this Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 A statement of purpose provided prospective service users with information about the home, however there are some details, which require amending or adding to this document to ensure it meets fully with the requirements of the regulation. Service users needs are assessed prior to being admitted to the home. The needs of service users are not being fully met, because the registered provider/manager has admitted service users that they are not registered to care for and they are waiting for social workers to re-assess their needs. EVIDENCE: The statement of purpose was assessed in detail at the previous inspection and found to have some areas for amendment and addition to ensure it meets fully with the requirements of schedule 1 of the regulations. 1, The service user category of registration is not detailed-this must be included as per registration certificate e.g. The age range and sex of the service users for whom it is intended that accommodation should be provided. 2,the range of needs that the care home is intended to meet, 3, whether nursing is provided. 4, whether the home intends to take, emergency admissions and how the service users Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 10 needs will be assessed under these circumstances, 5, change NCSC to CSCI on page 3, 6 and 15, 6, Include what arrangements are in place for dealing with reviews of the service user plan, referred to in regulation 15 [1]. 7, Include a list of the room sizes, 8, Amend the registered managers details to ensure there is no confusion regarding nursing qualifications. The requirement set for this and the target date for 15th September 2005 has not been met and therefore this requirement is now outstanding. There was evidence at the previous inspection that service users needs were not being fully met and that the dependency levels of service users admitted were of a fairly high level and that service users who had been admitted with dementia in 2002 onwards were naturally changing. Two service users were also at risk of wandering. This clearly had an impact on the other service users and the number of staff provided on each shift. The inspector requested that the manager obtain social worker reviews for those identified to be at risk of wandering. The registered manager informed the inspector that contact had been made with relevant social workers to arrange this. One service user reported that she had felt cold on the night prior to the inspection and wondered if the heating could be adjusted to meet with the change of temperature. Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 11 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): 8, 9, 10 Service users health, personal and social care needs are set out in individuals care plans, but there are still some areas which need to be improved to ensure the health and welfare of service users is fully maintained. There have been a number of issues to address in relation to the systems in place for medicines management. Service users and relatives feel they are treated with respect and their right to privacy is upheld. EVIDENCE: The manager and staff reported that regular monitoring was taking place, of service users who however there was still no evidence of this in relation to the documentation and clearly staff could not monitor the two service users who wander, when needing to attend and hoist other service users. The design of the building is also not conducive with clear observation of service users in the communal areas. A practice nurse was spoken with confirmed that there had been evidence that staff were not always following pressure relieving regimes and the District Nursing Team are involved in supporting the staff team in pressure sore care. Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 12 The previous inspection identified that staff team need to be more proactive in the prevention of pressure sores. The manager and staff spoken with confirmed that training is booked for staff to undertake training in continence management and pressure relieving regimes. The practice nurse did not have any concerns from the current visit but had only dealt with service users blood test this day. There had also been evidence that staff were practicing poor manual handling techniques and staff reported at the previous inspection that they had not undertaken training in manual handling for some time. A hoist is used for one service user and staff confirmed that two staff use this at all times. The manager reported that she had arranged outside training in the past, which had not been viewed, as satisfactory by the staff and the manager and she had now booked staff on a distance-learning package for manual handling practices. The inspector recommends that the registered provider ensure that competency assessments are carried out of staff to ensure that their practice conforms with training and that training needs to be accessed by recommended training bodies. A service user confirmed that staff were now using handling equipment such as belts and these were seen available in the home. A senior staff member confirmed she was up to date with manual handling practices as she had received training by another care establishment and that correct and proper practice was affirmed on her shift. Body maps are used regarding observations of bruising or marks and accident records were completed regarding skin tears and grazes. The manager, district nurses, relatives and social workers have not raised any issues in relation to unexplained bruising from poor manual handling practices. The manager stated that she would continue to monitor this area. One of the issues raised in the most recent complaint was regarding the use of a commode in the ground floor bathroom to toilet service users and the maintenance of cleanliness of this. The inspector was able to confirm that the commode is used for service users in wheelchairs when the disabled toilet is engaged, as the other remaining ground floor toilet is not accessible for wheelchairs. There are eight service users who use wheelchairs currently. The Registered Provider needs to consider the implication of not having a second accessible toilet when admitting service users who are not independent in using the toilet. The Pharmacist inspector made an unannounced visit to the home on 24th October 2005 in relation to issues identified at the previous inspection and her report is as follows: • A medication audit was carried out for a resident who was prescribed a course of antibiotics- Flucloxacillin 500mg capsules. The medication administration sheet indicated 8 capsules in total had been given, 8 DS0000008668.V253768.R01.S.doc Version 5.0 Page 13 Elizabeth House Care Home capsules remained on the premises but 20 capsules had been supplied in to the home. Four capsules remained un-accounted for. In addition this medication requires to be taken on an empty stomach or one hour before food but the Pharmacist inspector observed this being given with food by the senior carer. The Prescribers dosage regime was also not followed. This became a further concern, as this resident appeared unwell on the day of the inspection. • • An out of date Nitrolingual spray was located in the trolley for a resident. Two different types of laxative medication were not being administered as prescribed to a resident. Medication entering the home had not been accounted for. This also included Temazepam 10 mg tablets. An immediate requirement was set in relation to this. The compliance of these was assessed at this inspection and overall the management of medication was noted to be overall improved. A medication trolley is used to store medication and the system is more organised. Photographs of service users are included with the medication records and a sample of staff signatures was observed also. The manager and inspector discussed handwritten medication records and the following advice is given from the pharmacist inspector Handwritten mars- must be clear and a second trained carer must be used to verify that the information copied is accurate. It is also good practice to maintain a medication profile for each resident. Changed doses must be cross referenced in the residents daily/care plan notes. The doctor must provide the script or a fax of the new script with in 24 hours with the changed directions----see RPSGB guidelines verbal orders/ changed doses. Service users and relatives spoken with confirmed that privacy and dignity was respected at all times. Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 14 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): These standards were not assessed and were found to be met when previously assessed. EVIDENCE: Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 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): 16,18 Service users and their relatives are confident that their complaints will be listened to taken seriously and acted upon. Policies and procedures are in place to protect service users who are vulnerable, however good practice recommendations have been made to further improve this. EVIDENCE: A complaint was received by the CSCI on 23rd October 2005 and some of the issues raised were investigated at this inspection. The outcomes were that the complaints could not be substantiated; however recommendations are made in relation to the improvement and monitoring of practices. Service users and relatives spoken with during the inspection stated they had no complaints about the home. One service user reported that the manager was absolutely wonderful and would sort any problems straight away. The small conservatory area at the rear of the home leads to the laundry and other access door for the kitchen and the laundry door was found to be open once gain and posed a risk to service users who may wander in there. Cigarettes and lighters belonging to staff were left on the shelf and accessible to any service users who may wander in there. The inspector advised at the previous inspection that the fire officer be consulted regarding, fitting a keypad or similar to the interior door to the conservatory area to prevent access to the utility area by vulnerable service users. The manager reported that the fire officer has been informed and is going to visit the home in the near future. Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 16 A missing persons policy was in place and appeared appropriate, however it is recommended that the document, states that, all events of service users going missing must be reported to CSCI as required by regulation 37. One service user’s bedroom did have a bedroom door lock of a type fitted that could be more complicated to use and it is recommended that this be changed for one of the other types. A staff member spoken with confirmed that staff had not received training in abuse awareness Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Service users live in a generally safe, well-maintained environment, which was clean and free from mal-odour. There are some areas regarding the prevention of cross infection to address. EVIDENCE: The home is an older style domestic property with a more recent two floor extension.There are 14 single, and 1 double berooms, which are located on both floors and there is a passenger lift. There is a variety of lounge areas. There is a garden that is easily accessible for service users. There is limited car parking available on the homes driveway and further parking is available on the street. There are three lounge areas, one which doubles as a dining area and there is also a separate dining kitchenette. The home was clean and free from mal-odour. There were paper towels noted in bathrooms and toilets. However there were no paper towels in the kitchenette diner and fabric towels and tea towels were noted to still be in use Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 18 despite this being highlighted as an infection control risk at the previous inspection. The infection control policy has not been rewritten as advised. There was sudocreme and aqueous cream with the prescription label removed found in the ground floor bathroom and this is not good practice. A staff member removed these when pointed out. Other toiletries were stored openly also and it is recommended that these be either kept in service users rooms when not in used or kept in a lockable cabinet in the bathroom. Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 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): 27,29, 30 Staffing levels meet the minimum standards for the registration purposes of the home however, the dependency levels of the service users admitted is high and therefore it is strongly recommended that an extra staff member be employed to account for this. Staff training needs updating regarding manual handling practices and tissue viability. Recruitment practices were assessed as having major shortfalls and an immediate requirement set in relation to this. EVIDENCE: The rota was examined and staff confirmed the hours being worked were as recorded. Staff work appropriately, allocated shifts and two staff are covered on each shift. Domestic and catering staff are employed in addition to this. The manager reported she works as an extra staff member between 10am and 6.30pm weekdays. However on the day of the inspection the manager was observed to be in demand from telephone calls, management duties, relatives, GP visits/hospital appointments, assisting the inspectors and was very much needed to assist staff with attending service users needs. A number of service users were observed to need assistance with feeding. In light of the dependency levels of the current service users it is recommended that an extra member of the care staff, be employed to ensure that all the needs of service users is met. The manager should be super numery for at least 90 of her working time to ensure the legislative requirements and responsibilities of the home are maintained and met. The manager reported that she is to recruit a volunteer to assist with the issues identified as above. Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 20 A sample of staff files were examined and found not to meet with the regulations. An immediate requirement was issued in relation to this. Staff and volunteers had been employed without the appropriate recruitment checks. Staff must not commence employment without a POVA first check, two satisfactory references and a satisfactory CRB disclosure. Where the home is needing staff as a priority to maintain staffing levels, staff may commence duties with the POVA check and written references but must be supervised fully until the CRB is returned. Schedule 2 of the Care Home Regulations lists the requirements for documentation to be held in staff personal files. The staff file sat Elizabeth house were missing birth certificates, photographs, proof of identity and address besides the paragraph above. CRB’s from other establishments are not transferable. New CRB’s and POVA checks must be obtained for all staff unless transferring within the same company. Staff have now undertaken training in dementia care. Training in first aid, food hygiene and health and safety was evident. Training must be provided for staff in manual handling practices and for pressure sore prevention. It is recommended that the training be provided by an accredited trainer to ensure staff are updated with current practice. As stated the manager has confirmed and provided evidence these are booked. Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 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): 35, 36 Service users financial interests are safeguarded. Staff need to be appropriately supervised. EVIDENCE: A sample of service users financial records held by the home were assessed and found to be satisfactory. Evidence was seen in the staff personal files of appraisals but these had not been reviewed for some time. The manager acknowledged that the arrangements for formal supervision had lapsed and these needed to be reinstated. Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 22 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 1 X 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X X STAFFING Standard No Score 27 2 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 1 X X Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 23 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 2 3 Standard OP1 OP4 OP9 Regulation 4 Requirement Timescale for action 03/01/06 03/12/05 4 OP26 Ensure that the Statement of Purpose is amended as specified within the report 14, 16, 23 Ensure the home is heated to meet service users individual needs. 12,13, The Registered Person must Medicine immediately ensure all residents Act receive medication as prescribed by their GP, obtain a fresh supply of the Nitrolingual spray (with in 24 hours) and all medication entering the premises must be confirmed as correct on the day it arrives in to the home. This was found to be complied with on 1/11/05 16 Ensure paper towels are provided in the dining/kitchenette. 12, 13, 14, 16 Ensure the personal creams and any prescribed medications/shampoo of service users is not left in bathrooms or used for anyone other than for the person it is precscribed for. Ensure that staff and volunteers DS0000008668.V253768.R01.S.doc 01/11/05 03/01/06 5 OP26 03/01/06 6 OP29 18 01/11/05 Page 24 Elizabeth House Care Home Version 5.0 7 8 OP29 OP30 18 19 9 OP36 19 do not start work in the home until all the necesssary recruitment checks have been carried out. IMMEDIATE Ensure all staff files contain the documentation required by schedule 2 of the regulations Ensure all staff undertake manual handling training updates and pressure relief training Ensure staff have formal supervison re-instated 03/01/06 03/01/06 03/01/06 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 2 3 4 5 6 7 8 9 Refer to Standard OP4 OP8 OP18 OP18 OP18 OP26 OP26 OP26 OP27 Good Practice Recommendations Obtain service users reviews with social services regarding their placement at the home. Keep a record of observation checks for those service users at risk of wandering. Change the bedroom door lock on the identified service users bedroom door Seek advice from the fire officer regarding the safety and security of the utility area in the conservatory. Amend the missing persons policy to include notification to CSCI under regulation 37 Rewrite the infection control policy Provide a paper towel dispenser in the kitchenette /diner Review the arrangements for storage of toiletries in bathrooms Provide an extra staff member on each day shift Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Elizabeth House Care Home DS0000008668.V253768.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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