Inspection on 20/03/06 for Elmwood

This inspection was carried out on 20th March 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

Elmwood 02/08/07

Elmwood 26/03/07

Elmwood 13/06/06

Elmwood 19/01/06

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Elmwood 42-46 Southborough Road Bickley Kent BR1 2EW Lead Inspector Miss Rosemary Blenkinsopp Unannounced Inspection 20th March 2006 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 Elmwood DS0000066220.V286635.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. Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Elmwood Address 42-46 Southborough Road Bickley Kent BR1 2EW 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) 020 8249 1904 020 8249 4117 Mission Care Mrs Susan Diana Powis Care Home 67 Category(ies) of Old age, not falling within any other category registration, with number (66), Physical disability (1) of places Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 place registered for service user category PD for named service user only. Date of last inspection Brief Description of the Service: Elmwood is a purpose-built facility providing accommodation for up to sixtyseven service users in the category of older persons. It is located over three floors with a large reception area on the ground floor. The manager’s office is also located in this area. The middle floor is dedicated to intermediate care where the beds are funded through the Primary Care Trust. The maximum stay in this unit is six weeks. A multi disciplinary team of staff work intensively with service users to facilitate a move back to their own homes. The two other floors are for those service users in the category of older persons. These two floors provide long-term care and occasionally respite. Staff are allocated to specific floors to promote team working and provide a consistency of care. Each floor has a senior qualified nurse leading the team with support and ancillary staff. A qualified nurse manages the home. Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted by three inspectors who based themselves on a floor each. The visit was conducted unannounced for a period of approximately five hours starting at 10.30 am. The main focus of the inspection was to monitor progress on the medication systems and care plan documentation. In addition the level of staff activity, particularly during peak periods, was monitored. Again, there were issues with the care plans and medication identified on each of the individual floors. The inspectors need to be advised of what clinical support can be offered to the Manager as currently the organisation is without a Nursing Director. What the service does well: What has improved since the last inspection? What they could do better: Medication issues were identified on each of the three floors, which resulted in immediate requirements being made. The CSCI pharmacy inspector will be conducting a visit in respect of medication issues. Issues in respect of food including portion size, choice, and the serving of meals were also identified; these will also need to be improved upon. Elmwood DS0000066220.V286635.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. Elmwood DS0000066220.V286635.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 Elmwood DS0000066220.V286635.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): EVIDENCE: No standards were assessed in this section, however, information relating to standard 3, is included in the next section. Elmwood DS0000066220.V286635.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): 7,9. The care plan documentation is not sufficiently comprehensive in content to reflect the service users’ needs. In addition, when risks had been identified, there was little documentation in respect of managing this. Medications had limited supporting records and information was incomplete. Hand transcriptions, when used, were without two staff signatures to confirm accuracy of information. Storage and organisation of medication was poor in one area. EVIDENCE: Top floor - Care plans Two service users’ files were viewed, one of which was the last permanent admission and the other, a service user receiving respite care. Both contained an initial assessment although neither was fully completed. There were gaps in records for nutrition, weight, height and falls. One did not contain any medical information although it was clear that the service user had diabetes. The assessment format used a scoring system, although there was no guidance on what the scores meant. The RGN stated that she determined what it meant from viewing other paperwork. However, the inspector was provided with no information on whether the scoring was in relation to risk or Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 Page 10 dependency. A pressure risk assessment had been completed in one and a nutritional assessment in another. The waterlow score was 18, which is high risk, although there was no other record of interventions or risk assessment in the care plan. This was also true of the nutritional assessment. Some of the information had been transferred to a care plan in respect of one of the files viewed. However, this only covered personal hygiene and mobility. There were no other care plans or interventions in respect of health needs, social care etc. The second file viewed contained no care plan at all despite the service user being diabetic and requiring a diabetic diet. Top floor - Medication The inspector viewed the receipt, storage and disposal of medication on the second floor. The medication records viewed were mainly of a satisfactory standard of recording with hand transcribed medication records, in the main, showing two signatures confirming accuracy of the receipt of medication. The inspector noted that the medication received and returned for a service user on respite care had not been recorded. The inspector recommends that, where allergies are not known, this be recorded on the medication record. It was noted that several residents were on multiple medicines which meant they had several medicine charts. In the event that there is more than one medication record for the same person, this must be made clear e.g. records stating that this is the first of two. Medication in current use was stored in a trolley, with extra medication stored in cupboards within the clinical room. The medication stored in the clinical room cupboard was extremely untidy and poorly organised with medication for residents kept in different areas. Some medication, such as senna and dispersible aspirin had no labels attached. There was some medication already dispensed into cassette inserts. These did not have any labels attached and the bag in which they were stored had three different tablets lying at the bottom of the bag. The home had almost run out of oromorph for one service user; the nurse stated that although this had been ordered there were problems with the GP agreeing to prescribe more. The inspector also noted that the nurse on duty disposed of unwanted medication into the clinical waste bin without any record relating to what the medication was, the amount and reason for the disposal. There were also recording issues where medication had been taken out of the home. An example of this was of a service user having had leave from the home the previous day but no record made of this. The medication currently in use operates under different systems dependent on the admissions. For many, the medication is in the original containers with Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 Page 11 others in pre-dispensed packs. For some service users, the amount of prescribed medication is significant, which leads to difficulties in storage and therefore margins for error arise. The home must review their procedures and practices for new admissions to minimise the risk of errors occurring. Consideration should be given to nominating a designating individual to oversee medication within the home and review the storage. Ground Floor - Care plans Initial assessments had been completed in relation to both service users although not all areas of the template had been completed. Information in relation to allergies, waterlow score and the service users’ likes and dislikes had not been completed, all of which are important. It was particularly noticeable when one service user, who had an assessed need in relation to nutrition due to a low body weight at the time of admission, had no information on addressing this. Mission Care does not currently write to prospective service users stating that following assessment the home can meet the service users’ needs upon admission as required under Regulation 14. The care plan system appears to operate on a numerical scoring system, although neither the nurses nor Manager were able to demonstrate what the scores meant e.g. the level of risk, dependency etc. One service user had been awarded a score of 21. On enquiring if service users attained a place dependent on their score, the Manager did not know. The inspector noted that there was a care plan for one service user which provided information in relation to personal care, however, not for another service user. The Manager stated that this was because the latter did not require assistance with personal care as he managed this task himself. Discussion took place around the need to use an index system which would indicate the care plan format in its entirety, however clearly highlighting the relevant areas for each service user and those, which were not applicable. The current system leaves the person auditing the record not knowing if staff have forgotten to address a particular area of the service users care, or it is not required. There were other examples of this. Staff were maintaining a bowel chart for one service user appropriately but were also intermittently maintaining a chart for another service user who had no assessed need in relation to this issue. Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 Page 12 Both service users were assessed as needing assistance with bathing or a shower however there was not one entry since November 2005 to confirm that this task had taken place. One care plan indicated at the time of assessment the service user had been diagnosed with MRSA, however as the inspector worked through the care plan it became evident that this was no longer present. Discussion took place with the Manager regarding the importance of regularly archiving information to ensure that all current and important information is kept up-to-date and easily accessible. Ground Floor - Medication None of the service users on the ground floor is currently self-medicating. A small clinical room is situated on the ground floor; the door to this remained unlocked throughout the inspection, with or without staff present. The keys were in the fridge door although the nurse was in the room at the time. Both trolleys containing medication were secure. Although rather untidy the room did not contain any other items other than those related to service users medication or health. The nurse in charge stated that the medication arrived two days in advance to enable them to check and prepare for the start of the following cycle. The nurse in charge stated that a record is kept of the signatures for all staff responsible for administering medication. However this is kept in the main office and not in the clinical room for easy reference. The MAR sheets and medication for five service users were examined, the following observations were made. Handwritten entries on one MAR had been signed by two members of staff, two MAR sheets had handwritten entries, which had not been signed or dated. The MAR sheet for one service user had been amended by hand to indicate a change from a specified daily dose and time to PRN. Staff had not signed and dated when the change had been made and had no written evidence that the GP had provided information regarding the change in administration. Two large containers had been provided for the purposes of storing medication awaiting disposal, the majority of discontinued medication was in a large open cardboard box in the clinical room. There is currently no written system in place to record the medication leaving the home for disposal. The inspector observed a carer return two tablets to the nurse station, which she left on top of the desk. When this was queried, she stated they had been left in the dining room and she was leaving them there for the nurse to deal Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 Page 13 with, once she had finished the drug round. They had been left ithe dining room. This was discussed with the nurse in charge. Some improvement had been made since the last inspection. Previously the use of a hole punch on MAR sheets meant it was not possible to see the names of all medications in full. It was clear that action had been taken to address this issue. Intermediate care unit - Care plans Two care plans were randomly selected. The first was of a resident admitted on 7 March 2006. The FACE assessment was partially completed although it contained no date or name of the assessor. The health screening was partially completed; medication was not completed nor was the weekly activities or the social support information. Details on family and carer input was also not completed. This was almost three weeks after the admission and some of this information must have been available. Within the medical history was reference to a number of significant health problems, however, none of these were included in the current care plan. Only one issue was indicated on the care plan, which was in relation to mobility. The waterlow score was not dated. The falls form indicated a history of falling, this would have been compounded by the fact that the service user had recently had a bi lateral knee replacement. Robust risk assessments need to be in place with specific interventions detailed to reduce the risk. The current standard falls form does not provide this. The second care plan was reasonably well completed with dates in place and signatures. Within this care plan it was noted that the service user had a high waterlow score and indicated she was at risk of pressure sores although had not had a review conducted since the initial assessment. In the event that risks are identified actions must be taken to reduce these with reviews conducted at regular intervals to monitor the situation. This care plan had four problems with interventions and reviews documented. There was nothing in respect of social activities or preparation for returning home. In both cases it was not possible to locate the service users weight, which is essential for manual handling and many other relevant assessments. Medication -Intermediate care unit Generally the standard of documentation in respect of medications was unsatisfactory and would introduce an element of risk to the service users. The codes used on medication charts were incorrectly used. Information on Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 Page 14 medication charts was poorly completed, including information stating what form the medication should be administered in, i.e. tablets, liquid. One medication had no dose stated. The directions for administering Paracetamol were confusing stating as required (PRN), and four times a day (QDS). Abbreviations were used including those not commonly referred to e.g., NKDA, which means, no known drug allergy. This practice should be avoided. One medication had been recorded as having been refused for 23 days but no review of this had been undertaken. Hand transcriptions on medication administration records (MAR), south wing, were without the amount of medication received, or staff signatures. Some service users photographs were missing. Two eye drops had expired within the medication cabinet. Staff were asked to dispose of these. The controlled drug cabinet was out of use; the inspector was advised this was due to a problem with the locks and keys. The cabinets are due to be replaced and the order form relating to this was forwarded to the CSCI. In the interim period safe storage for controlled drugs has been found within the home. The “sharps” bin contained inappropriate items other than needles and sharps, such as cotton wool. Immediate requirements were left as a result of medication practices, organisation and storage. Please see requirements 1, 2 and 3. Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 Page 15 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): 15 Choice of food, portion size and the serving of food all need to be improved upon to ensure service users have their nutritional needs met. EVIDENCE: Top floor There was a flood emanating from the first floor sluice. Whilst staff were addressing this, service users were having lunch. The noise from the machinery used to address the flood was very loud and close to the dining room. Service users were affected as no-one had thought to close the dining room doors to limit the noise. Of the meals observed one service user was served mashed potatoes even though she has informed the home she did not like these. Staff then placed boiled potatoes on the plate. No consideration was seen to be given to service users likes or dislikes. Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 Page 16 Ground Floor Discussion took place with the Manager regarding the current system of recording information in relation to service users’ activities. Staff responsible for providing activities keep a comprehensive record, however, information regarding all service users is on one page, which contravenes the guidelines in relation to residents’ contracts . Whilst the inspector appreciates that it would be a very time-consuming exercise for activity staff to go around the home writing information on each persons care plan, the system of recording does need to take into account the issue of service user’s confidentiality. It would be helpful for nurses and care staff to have some information regarding service users’ hobbies and interests to arrange activities on other less formal occasions during the week. The midday meal was served during the course of the inspection. One service user stated the portions were very small and he felt he did not have a good variety of food as he did not eat chicken or pork, he acknowledged that the chef always provides an alternative for him, (records of alternative meals provided to him are recorded by the chef and were seen). Two other services users stated they always enjoyed their food, which was always well cooked. Service users stated staff were very nice and kind to them and provided the help and support they needed. However they all commented on how busy staff were, how much work they had to do and that they are always in a hurry etc. The inspector did not see any staff talking to service users in the lounge during the time she was there as they were undertaking care or household tasks. A relative spoke with the inspector and stated he and the rest of the family thought the home was always clean and free from unpleasant odours. In addition, staff were good and they were always made to feel welcome when they arrived. He stated his mother had now been in the home a number of months and he had never had to complain about the care or service provided. Please see requirement 4. Please see recommendation 1. Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 Page 17 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): EVIDENCE: No standards were assessed in this inspection Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 Page 18 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): EVIDENCE: The environment was not inspected although it was noted on the intermediate care unit that several of the swing bin lids were missing. In addition the bathrooms were very congested with items such as laundry bags and wheelchair attachments. Elmwood DS0000066220.V286635.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): 27,30. Staffing levels need to be sufficient to meet service users needs and staff provided with adequate breaks during their working day. All staff must be given sufficient information on induction so that they can undertake their work. EVIDENCE: Ground Floor Nurses were clearly disgruntled at the reduction in the number of carers on the floor. This had fallen from 5 to 4 to 3 on the day of the inspection as it was not possible to cover sickness. This resulted in nurses having to serve meals, do some washing up and provide assistance for service users requiring assistance with going to the toilet, in addition to their clinical responsibilities including medication and care plans. The Manager stated that to her knowledge agency staff had only provided cover on one occasion for one shift, when it had proved impossible to cover a shift from existing or bank staff. The Manager pointed out the staffing levels on the day of the inspection were still in excess of the home’s staffing notice. Two qualified staff were on duty rather than one. The inspector pointed out the economic disadvantage of nurses undertaking basic care duties. The Manager did not think this was an issue and stated she believed it was important for nurses to be seen to do these tasks by the carers. Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 Page 20 Intermediate care unit On the intermediate care unit several staff were without uniforms. Their standard of dress and general attire did not give an impression of professionalism with large hooped earrings, jewellery and very casual clothing. On the day of the inspection there were twenty-two residents on the intermediate care unit. Three qualified staff were on duty with four care assistants. Originally there had been five rostered, but due to shortages on another floor staff had been sent to help. This occurred on a regular basis the inspector was told. On occasions the afternoon staff had three care staff on duty, the inspector was advised. This was felt to be inadequate to provide care. Staff were busy during the period spent on the unit. The work is made particularly heavy because of frequent escorts, daily GP visits and multi disciplinary meetings. In addition the focus of this unit is on rehabilitation, where service users address their own needs with staff support rather than staff providing care, which is very time consuming. One staff member advised the inspector that during the afternoon period, when staff were working long days they were not provided with a break. This could mean periods of eight to nine hours are worked without a break, this is not acceptable. Senior staff must organise staff to ensure that breaks are provided at regular intervals. A newly appointed staff member was unable to confirm that she had received information in respect of fire drills, COSHH or first aid. Other areas, on which she had limited information provided, were manual handling and MRSA. Please see requirements 5 and 6. Elmwood DS0000066220.V286635.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): EVIDENCE: No standards in this section were assessed. Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 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. Standard OP3 Regulation 14 Requirement The Registered Manager must ensure that all residents are appropriately assessed including nursing input, prior to admission. The home must confirm in writing its ability to meet service user needs. This is now outstanding, previous time frame for action 28/02/06 The Registered Manager must ensure that care plans, risk assessments and all supporting documentation is completed on all residents with comprehensive interventions on how to address the problems identified. This is now outstanding, previous time frame for action 28/02/06. The Registered Manager must ensure that all records relating to medication procedures and administration are fully completed. All medication procedures must be safely applied. This is now outstanding, previous time frame for action 28/02/06. DS0000066220.V286635.R01.S.doc Timescale for action 28/05/06 2. OP7 15 28/05/06 3. OP9 13 28/04/06 Elmwood Version 5.1 Page 24 4 OP15 16 5 OP27 18 6 OP30 18 The Registered Manager must ensure that service users are provided with food in sufficient quantities, and meals are served in congenial surroundings. The Registered Manager must ensure that staff are provided in sufficient numbers to address service users’ needs. The Registered Manager must ensure that all staff receive sufficient induction to equip them with the skills they need to undertake the work they do and thereafter ongoing training 28/04/06 28/04/06 28/04/06 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 OP15 Good Practice Recommendations The Registered Manager should ensure that residents are offered a choice of meals Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Elmwood DS0000066220.V286635.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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