Inspection on 11/02/08 for Fairmount

This inspection was carried out on 11th February 2008.

CSCI found this care home to be providing an Good service.

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

Other inspections for this house

Fairmount 30/01/07

Fairmount 08/08/06

Fairmount 23/11/05

Fairmount 11/05/05

Fairmount 13/01/05

Fairmount 05/07/04

Fairmount 12/03/04

Similar services:

Ashlong House

Norbury Crescent (30)

Henry Nihill House

Birchwood

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

The Infirmary

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

CARE HOMES FOR OLDER PEOPLE Fairmount Mottingham Lane Mottingham London SE9 4RT Lead Inspector Ann Wiseman Unannounced Inspection 11th February 2008 06:00 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 Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairmount Address Mottingham Lane Mottingham London SE9 4RT 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 8857 1064 020 8402 7401 info@fairmount-of-mottingham.co.uk Mrs Jenny South Mr Harold South Mrs Maria Jacoba Wilhelmina Saward Care Home 38 Category(ies) of Dementia (38), Learning disability (1), Old age, registration, with number not falling within any other category (38) of places Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE 2. Learning Disability - Code LD (maximum number of places:1) The maximum number of service users who can be accommodated is: 38 30th January 2007 Date of last inspection Brief Description of the Service: Fairmount is a large detached house set in its own landscaped grounds. It is a Grade 2 listed building, having been the home of W.G. Grace the noted cricket player. The home provides care and accommodation for older persons including those with dementia. The home caters for up to 38 people and there are bedrooms on all three floors accessed by two passenger lifts. There are various lounges and sitting areas, and all public areas of the home are accessible to everyone. There are grab and handrails in the passageways, stairs, toilets, showers and bathrooms. Specialised bathing and toilet equipment and lifting aids are available. All toilets, showers, bathrooms and bedrooms have lockable doors, which can be accessed from the outside, in case of an emergency. The home has been extended with furnishings and facilities to a high standard. Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced inspection and we arrived at the home at 6am before the early shift had arrived and we had an opportunity to speak to the night staff. The manager came on duty at 8 o’clock and answered our questions and produced the files and information we asked for. We spent 7 hours at the home. During that time we talked to staff members and some of the people living in the home. We had previously send questionnaires to people asking them what they thought of the home and eight were returned and three professional involved with the home have also given us their opinion. The manager had sent us the Annual Quality Assurance Assessment (AQAA) she had completed. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. We were able to use the AQAA to form an opinion on how the manager was developing the service, what she thought they did well and what areas needed improvement. The Manager has been in post several years, she is experienced and holds relevant qualifications. The capacity of the home has recently been increased from 35 to 38 beds. What the service does well: The home is clean and nicely decorated with homely features such as ornaments, flower arrangements and many pictures on the wall throughout the Home. There is an ongoing program of decoration and refurbishment and several bedrooms and communal areas have been decorated since the last inspection. The environment is of a high standard throughout the home. The garden is very attractively laid out and offers sheltered and safe areas to walk. There are decked walkways around parts of the home with easy access for people using a wheelchair. There is an established staff team who appear to be supportive and caring. Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 were examined on this occasion. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People have their needs assessed prior to them moving into the home. Fairmount does not offer intermediate care. EVIDENCE: We looked at four files of people living in the home they all contained assessments. They were completed by either a care manager or the home; people thinking of moving in visit the home for half a day to see if they think it will be able to meet their needs and during the visit a senior care staff will carry out the assessment. Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 and 11 were examined on this occasion. People who use the service receive Adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Care Plans are in place but are not reviewed or updated often enough. Health care is provided, medication is stored well but some medication practices need to be reviewed and improved. The home does not ask people how they would prefer to be cared for in illness and death. EVIDENCE: Care plans are detailed and but are not reviewed or updated as often as they should be. They contain lists of each person’s medication and when they were checked against present medication sheets the two did not correspond. Tablets that had been changed or stopped had not amended on the care plan. This could lead to misunderstandings and mistakes that may affect the health and wellbeing of the person taking the medication. We examined the daily records that are designed to reflect the daily activities of the people in the home. What was written was very brief and held very little information. In one there was two pages of “slept well”, “good appetite”, Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 10 “appears well” then out of the blue “…..Appears well, started a course of antibiotics this morning, no other complaints” There was no suggestion that this person had been ill or off colour and there was no explanation why they had seen a doctor or why the antibiotics were needed. There were no further mentions of either the person’s health or the medication. Also, when we compared the mental picture drawn by the daily records they did not match that in the care plan. One care plan talked about the person being pleasant and well mannered, easy to get along with and compliant with taking medication, in reality the daily notes showed a person that was unsettled, hid their medication and displayed challenging behaviour and could be aggressive towards staff and other people living in the home. It is expected that we are able to recognise the real person in the care plan, the plan’s purpose it to set out in detail each persons health, personal and social needs and the action care staff need to take to ensure that these needs are met. It is required that daily information is detailed enough for care staff and healthcare professionals to be able to track wellbeing and changes to peoples needs. So that care plans can be reviewed and updated to properly reflect the person’s changing needs. The surveys that were returned to us and the people we talked to while we were at the home, all said they felt that the staff treated them with respect and upheld their privacy while they were helping them. All the people living in the home are registered with a doctor and receive appropriate treatment. Doctor’s visits are recorded and necessary actions are passed on at hand over sessions between shifts and recorded on the persons file. Evidence was also found that people have their other health care needs met such as optician, dentist, psychiatry and other specialists. Comments made about the home by the doctors who treat the people living in the home were positive. One said, “ They try to ensure that the people in their care lead as comfortable life as possible in excellent surroundings and care.” The Medication, its storage and records were examined during this visit. The home has the medication dispensed into blister packs by the chemist who also produces record sheets referred to as MAR sheets. There were gaps in the MAR sheets where staff had not signed to indicate that the medication had been given. We checked the blister packs and the medication had gone. There was also medication still in the blister that should have been given. When the records were examined they recorded that the person was asleep at the time the medication was taken around or was out of the building. There was no evidence that arrangements had been made to give the medication once people had woken up or come back from their outing so the dose was not given at all. This is a very dangerous practice and could adversely affect people’s health. Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 11 The charts and blisters are checked at the end of the month but it is not apparent that action is taken if medication is missed or there are signatures missing from the recording sheet. It is important that proper checks are made and that the manager investigates mistakes and omissions and takes appropriate action to stop poor practice. Some people were prescribed medication or had the dose changed after the monthly cycle had been started, the details had been hand written and not countersigned. It is unsafe to handwrite medication details on records because if it is recorded wrongly or the handwriting is poor it will lead to mistakes being made that may affect the health of the person receiving the medication. This practice is against the Royal Pharmaceutical guidelines; they recommend that instructions should be printed by the pharmacy that dispensed the medication. They should only be hand written if it really can’t be avoided and then two people must check the entry and both must sign the entry as correct. How the home would support people as they become older and face death is not fully addressed either in their statement of purpose, user guide or in peoples care plans. The quality of the care that people receive in their last days is as important as the quality of life that they experience prior to this. This means that their physical and emotional needs must be met, their comfort and well being attended to and their wishes respected. People living in the home should be encouraged to express their wishes about what they want to happen when death approaches and to provide instructions about the formalities to be observed after they have died. For example do people want to be cared for at home or would they feel safer in hospital and who would they like to be notified is the event of a serious illness or death. Cultural and religious preferences must be observed. There should also be an openness and willingness on the part of staff to talk about dying and death and about those people who have recently died. Staff in turn should be properly supported during the difficult time of caring for someone as they face death. It is essential for the home to have clear polices and procedures about how they ensure that people’s last days are spent in comfort and dignity and that their wishes are observed throughout. Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were examined on this occasion. People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Family and friends are encouraged to visit; visitors are accepted at any reasonable time and can sit with their relatives who are ill for as long as they want to. People who live in this home are given opportunities to make choices and to control their lives. Food is well presented and looked appetising. EVIDENCE: Those asked said that the home was a good place to live and that they felt that they were able to make decisions for themselves and exercise choice. The home has an activities coordinator who is popular and was singled out for mention by the people we spoke to. They said she took time to listen and that they enjoyed the activities she arranged. There is a calendar of events including craft and sing along sessions, live performances from local musicians, coffee mornings and visits from a local school with whom they have close contacts. Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 13 The home has a full time gardener and the garden is well kept and attractive. There is a pond and ample seating with an area of decking close to the house that is sheltered and gives people with poor mobility easy access to the garden. People would be able to assist with gardening if they want to. There are shops and pubs locally and people are supported and enabled to go shopping or enjoy a pub trip. Religious services are held regularly in the home. Family and friends are made welcome and are invited to eat at the home if they arrive at a mealtime. People chose between two meals for dinner and the cook will prepare alternatives on request. The manager has told us that there are plans to refurbish the dinning room in the near future. Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,17 and 18 have been assessed during this inspection. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People living in this home and their families can feel confident that complaints will be taken seriously and acted on. The home’s recruitment process and training protects people from abuse. EVIDENCE: Where people lack capacity the home makes arrangements for someone to act on their behalf, either a family member or an independent advocate. Evidence of this was seen recorded in peoples files. The homes statement of purpose and users guide contains the homes complaints procedure. There is a complaints leaflet that also sets out the home’s procedure and it is given all of the people who live in the home. We looked at the way the home recorded any complaints and found that it was done in a way that made it easy to follow a complaint from start to finish. The home has policies and procedures about responding to suspicion or evidence of abuse. We were assured that staff have received protection of vulnerable adult (POVA) training. The staff files showed evidence that it had been done and staff confirmed that they had taken the course. When questioned about adult protection they displayed knowledge of how they would disclose an abusive situation they had witnessed or suspected. Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were examined during this visit. People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The entire home is well appointed, nicely decorated and comfortable. The home is clean, pleasant and hygienic. EVIDENCE: Facilities in the Home are well maintained and comfortable, the communal rooms are pleasant and well decorated. There is an ongoing program of decoration and refurbishment and some of the bathrooms have recently been improved and updated. Over the recent years the house has been extended to a high standard and the number of beds have been increased. The home is clean and hygienic. The home and entrance hall had a pleasant odour. Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were judged on this occasion. People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. There is sufficient mix of skilled and qualified staff on duty to meet the needs of the people during the day but the manager needs to regularly reassess whether there is sufficient staff on duty at night as the needs of the people living in the home changes. There is a varied list of training available and the recruitment process is to requirement. EVIDENCE: There are sufficient care and domestic staff on duty to meet the needs of the people living in the home during the day. We have been informed that there are five carers on duty during the early shift, four on the late shift until 8pm. Then there are two waking night staff and another carer who stays until 10pm. However we were unable to confirm this because the home does not retain copies of duty rotas of staff working at the home that record whether the rota was actually worked as required in schedule 4. We had been contacted by people who voiced concerns about the staffing levels at the home since the extra rooms have been put into service. They do not want to be identified but their main concern was that the increase in beds has not been matched by an increase in staff. They feel that this is putting the people living in the home at risk especially during the evening and at night. There is only two waking night staff on duty to cover all three floors. Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 17 While we were given a tour of the building we paid particular attention and made an assessment as to whether two people would be able to protect people from harm at night. Staff often have to work together in assisting people and it is our opinion that it would be difficult for staff working at one end of the home to be aware of what is happening at the other end. They may not be in a position to offer support quickly in another part of the home. We also took into account information contained in the Annual Quality Assurance Assessment and information found in the records. The daily notes record that there are often several people up and about during the night, some people just need support to go to the toilet and others wander around the building. On one occasion someone was found in the garden after the door alarm alerted the staff and on another occasion it had not been noticed that someone had left their room and had spent most of the night asleep in an unoccupied room. Neither people came to harm but nor could they be considered to be properly supervised. There is a regulatory requirement that staffing levels and skills mix are adequate to meet the assessed and recorded needs of the people living in the home at all times. It is the manager’s responsibility to satisfy us that she has properly and realistically assessed those needs and has appropriate numbers of staff on duty to keep people safe. We were assured in discussion with the manager and later with the managing agent that since the increase in beds individual night risk assessments have been completed. They feel that the assessments show that adequate staff are employed at night to keep people safe. The home is going to install a new system that will monitor the visits people get at night from staff and it will be able to generate information that will help with assessing the level of care that people need. This information will be used when further examination of staffing levels are made, which must be kept constantly under review. Information given to us in the Annual Quality Assurance Assessment says that the home has met the minimum requirement of 50 of its staff having attained the NVQ2 qualification or above and it has a rolling program of NVQ training. The Home does not use agency staff as part time staff cover additional shifts. The Home is a member of a training consortium. The training program includes core training such as First Aid, Fire, Infection Control, Manual Handling and Medication. There is also specialised training offered: Understanding Older People, Dementia, Depression in Older People and Report Writing. Staff interviewed appeared Knowledgeable and caring. The home has a very small staff turn over and the home’s recruitment policy follows the requirements and no staff are employed without first having a clear police check and obtaining two references. Staff we talked to confirmed that the procedures had been followed in their recruitment. Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 have been examined for this inspection. People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The Manager is knowledgeable of the needs of the people living in this home. The home is run in their best interests and the home is a safe place to be. Fire procedures need to be updated and more fire drills must be done. EVIDENCE: The Registered Manager has a good understanding of the needs of older people and has undergone the registration process and has been judged as a fit person to manage a care home People living in the home are given the opportunity to have their say in the running of the home at user meetings, also they and their next of Kin are sent Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 19 Quality of Care Assessment forms annually. Information received in the survey is collated and is made available for interested people to read. The home does not deal with any of the people’s monies; if any one is unable to manage their finances their next of kin is asked to take responsibility or an independent appointee is allocated. The building has a rambling layout and bedrooms are on all three floors. The fire risk assessment was done with advice from the fire officer after the increase in beds. We examined the fire procedures and records. Fire drills are carried out and are recorded but not enough are done and none have been carried out at night. The fire procedure has not been reviewed since the extension of the building and nor are there specific and detailed guidance on how the night staff should act in the event of a fire at night. The manager acknowledged this shortfall and has undertaken to increase the number of fire drills and to include some to be held at night and to arrange for staff to undergo the required number of fire training sessions, of one every six months for day staff and three monthly for night staff. Two locks, a safety chain and bolts secure the front door, this is the main entrance and is a fire door. It should be easily opened in the event of an emergency. Advice should be sought and a safe means of locking the door found that does not contravene the fire regulations. Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Timescale for action 30/06/08 2 OP27 18 3 OP27 Schedule 4 It is required that daily information is detailed enough for care staff and healthcare professionals to be able to track wellbeing and changes to peoples needs and that care plans are reviewed and updated to properly reflect the person’s changing needs. 30/06/08 There is a regulatory requirement that staffing levels and skills mix are adequate to meet the assessed and recorded needs of the people living in the home at all times. It is the manager’s responsibility to keep this under constant review and to be prepared to make changes to staffing levels if peoples needs change and make it necessary to keep people safe. The home must retain copies of 30/06/08 duty rotas of staff working at the home that record whether the rota was actually worked as required in schedule 4. Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 22 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 It is recommended that all staff must have their training on the safe handling and administration of medication undated and have their abilities to work within the homes medication policy and procedures reassessed and these assessments must be retained on file. It is recommended that the home should address the issue of people ageing, becoming ill and dying in the statement of purpose, user guide and individual care plans. The fire procedure has not been reviewed since the extension of the building and nor are there specific and detailed guidance on how the night staff should act in the event of a fire at night. Also the number of fire drill should be increased and should include drill carried out at night. Advice should be sought and a safe means of locking the door found that does not contravene the fire regulations. 2 3 OP11 OP38 4 OP38 Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Fairmount DS0000006924.V358901.R01.S.doc Version 5.2 Page 24 - 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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