CARE HOMES FOR OLDER PEOPLE
Garden House Priestlands Sherborne Dorset DT9 4HN Lead Inspector
Mike Dixon Unannounced 31 August and 19 September 2005 10:00 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 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. Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Garden House Rest Home Ltd Address Priestlands, Sherborne, Dorset, DT9 4HN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01935 813188 Garden House Rest Home Ltd Mrs Gillian Houghton CRH PC - Care Home Only 15 Category(ies) of OP Old age (15) registration, with number of places Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 2nd March 2005 Brief Description of the Service: Garden House is a residential home registered to accommodate 15 older persons. It is situated in a quiet residential area of Sherborne and within walking distance of the town centre. Mr Calder purchased the home in 1992 and continues to take an active role in the management of the home. He lives in private accommodation within the grounds of Garden House. In August 2005 a new registration certificate was issued to reflect the fact that the home is under the ownership of Garden House Ltd (the change to a limited company occurred in 1999). Mr Calder is the responsible inidvidual and Mrs Houghton is the registered manager. The home is established in the main house and an extension to the property named Trudy’s Cottage and is set in landscaped grounds. The front garden is set to lawns and herbaceous borders with mature trees and shrubs and a parking area for visitors convenience. A series of steps lead to the front entrance and a large sliding glass door/window at the front of the house allows access to a raised patio area with garden furniture. The back garden has mature fruit trees, lawns and seasonal flower borders. Once inside the home there is level access to residents’ rooms and communal facilities. The accommodation is furnished and decorated to a high standard. Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by the Commission as part of its regulatory duty to inspect all care homes twice a year. The purpose was to assess the home’s compliance with some of the key national minimum standards for older persons and to review the requirements and recommendations from the previous inspection report. The inspection took place over two days, lasting a total of six hours. The main part of the inspection was completed on the first day by M Dixon; on the second day, C Main, the pharmacy inspector visited by appointment and looked at the medication arrangements at the home. During the time spent at the home the inspectors spoke with eight service users, Mr Calder, Mrs Houghton and three staff members. The inspectors visited all communal areas and a sample of bedrooms. They looked at the kitchen, laundry room, medication cabinet and a variety of records and documentation relating to the running of the home. What the service does well:
Service users were very complimentary about the quality of the care which they received and about the kindness and consideration shown by the staff. Comments such as “the staff are excellent”, “the staff are always willing” and “they take great care of me” reflect the views of the eight service users with whom one of the inspectors spoke during the course of the visit. Staff members were observed to approach service users in a courteous and friendly manner. There was a pleasant and informal atmosphere in the home. Service users are encouraged to retain control over their own lives and to “personalise” their bedroom. They can receive visitors whenever they wish and their visitors are always made welcome by the staff. Service users enjoy the meals at Garden House. One service user commented “the food is always a pleasant surprise”. Meals are prepared from fresh ingredients and are prepared in the style of “home cooking”. The accommodation is generally well maintained and is suited to the needs of service users who are currently living at the home. The rooms and areas that are accessed by service users are light, clean and odour-free, providing a pleasant and comfortable environment for service users. Bedrooms have sufficient light, they are well ventilated and stay warm in cold weather. Service users are happy with the laundry provision.
Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 Page 6 The home is suitably staffed with a well-motivated group of staff. There is an open style of management at the home which encourages service users to feel confident about raising issues and to participate in decision-making. Staff members enjoy working at the home and consider that they are well supported by the management. What has improved since the last inspection? What they could do better:
The statement of purpose and service user guide must be amended to comply with regulations. The service user guide should include the address and telephone number of the Commission and of the local Social Care and Health office. Evidence of consultation with the service user and/or his/her representative must be documented with regard to the care plan. The home must make a number of changes to the medication administration and recording system to provide better protection for service users. The home should also make improvements to the medication policy and should make arrangements for the safe storing and handling of controlled drugs in accordance with the guidance from the Royal Pharmaceutical Society. Information regarding service users accessing their personal records in accordance with the Data Protection Act 1998 should be included in the service user guide. The record of meals provided should be amplified to better demonstrate the range of items offered. The complaints procedure must include the correct name of the regulatory body, the Commission for Social Care Inspection and should inform the reader
Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 Page 7 that he/she can make direct contact with the Commission at any stage of the complaint process. The wording of the adult protection procedure should be amended to make it clear that no investigation of an alleged abuse incident is investigated by the management prior to obtaining the approval of an officer from Social Care and Health. All night staff members must receive fire instruction at quarterly intervals and all day staff at six monthly intervals. Visual checks to hand-held fire-fighting equipment must be carried out each month and a record kept. The registered person must arrange for the checking of all portable electrical appliances by a suitably qualified person. The fire risk assessment should be reviewed at least annually to ensure that it includes all relevant aspects and that it reflects the situation and practice in the home. The registered persons should commence a programme of fitting the type of bedroom door lock which enables service users to safely lock the door from both sides, by means of a key on the outside (providing staff with access by means of a “master” key in case of an emergency). Risk assessments conducted in respect of hot water temperatures must be sufficiently comprehensive and up-to-date to take into account the circumstances of service users, including communal areas to which they have access. The risk assessments with regard to radiators must be kept under review to reflect the changing circumstances of service users. Where there is a significant identified risk to the safety of service users remedial action must be taken. A programme to fit guards to radiators and to limit hot water temperatures to 43 degrees centigrade at hot water outlets to baths and washhand basins should be implemented. The responsible individual (Mr Calder) should compile a job description for the manager. The manager should check with the awarding body to ascertain if her qualification also equates to NVQ level 4 in care. 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. Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 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 standard(s) 1 The information supplied to service users prior to admission is helpful but it does not contain all the necessary information to enable service users to make an informed decision about the home. EVIDENCE: Prospective service users and/or their representative are offered a copy of the home’s statement of purpose. The document includes useful information about the home but does not yet contain all the details that are set out under the regulations and national minimum standards. The statement of purpose, service user guide and a copy of the latest inspection report are held in the front hall and are available to all visitors. Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,9 and 10 Care plans provide information to staff about the needs of service users but they do not demonstrate that the content is in accordance with service users’ wishes. Staff members treat service users with respect and dignity, promoting service users’ feelings of worth as valued members of the household and community. The standard of recording and handling of medication in the home is poor and potentially places service users at risk. EVIDENCE: Each service user has a care plan. In discussion with the inspector, service users confirmed that the help which staff members provided was in accordance with their wishes and needs. Written evidence that service users are consulted regarding the content of the care plan and subsequently in reviews is still lacking. Service users were very complimentary about the quality of the care which they received and about the kindness and consideration shown by the staff. Comments such as “the staff are excellent”, “the staff are always willing” and “they take great care of me” reflect the views of the eight service users with
Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 Page 11 whom one of the inspectors spoke during the course of the visit. Service users are able to pursue their preferred lifestyle and interests, their privacy is respected, they choose when and how often they have a bath; in summary, they retain control over their own lives. Staff members were observed to approach service users in a courteous and friendly manner. There was a pleasant and informal atmosphere in the home. The home does not have a full medicines policy; guidance on improving this has been provided. Two service users were self-administering some of their medicines but there were no recorded risk assessments and this was not clear from the Medicine Administration Record (MAR) charts. Most medicines were dispensed by the pharmacy in weekly cassettes and the manager told the inspector that they were checked on receipt. However, six medicine records on five of the MAR charts, handwritten in the home, did not agree with the medicines in the cassettes. In three other cases the strength or dose was wrongly recorded and some medicine names and strengths were not fully recorded. The medicines in the cassettes checked agreed with the current prescription so these medicines probably were given as prescribed despite the errors in the records. From checks of medicines not in cassettes 3 doses of one antibiotic had not been given as prescribed and recorded. The audit of another agreed with the records of administration. The records of receipt of medicines were incomplete and did not always include the quantity. Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,14 and 15 The home makes visitors welcome and thereby helps, service users maintain contact with the local community. The home serves nutritious and well cooked meals which meet the expectations and dietary needs of service users. EVIDENCE: Service users receive visitors whenever they wish and their visitors are always made welcome by the staff. One service user commented “there’s always a cup of tea (for visitors)” and an example was given of an occasion when four visitors who had travelled a long distance to see a service user were provided with a meal. It was evident to the inspector from speaking with service users and staff members that friends and relatives of service users were encouraged to participate in the life of the home and to maintain contact. Information regarding visiting arrangements is contained in the statement of purpose. Service users are able to personalise their bedroom by bringing in items of furniture or other features of interest. They look after their own financial affairs or are assisted to do so by a relative or other representative. Information regarding accessing external advocates is available. There is information in the home’s statement of purpose about service users accessing
Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 Page 13 their personal records if they wish but no mention is made of the Data Protection Act 1998. Service users enjoy the meals at Garden House. One service user commented “the food is always a pleasant surprise”. Meals are prepared from fresh ingredients and are prepared in the style of “home cooking”. There were good supplies of fresh fruit and vegetables in the store room. The eight service users with whom the inspector spoke all confirmed that the standard of food was very good or excellent. Account is taken of service users’ likes and dislikes and of any specific dietary needs. Some service users choose to have their meals in their bedroom or in one of the two pleasant and light communal rooms. Service users are asked informally for their views and comments on the menu. A record of meals is maintained, including the individual choices that service users make at tea-time. More detail would give a better idea of the range of items offered; for example, soup is offered every day but the record does not say which kind of soup it is. Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The complaints procedure is not sufficiently comprehensive to provide service users or their representatives with all the information they might need to pursue a complaint. The measures in place for responding to allegations of abuse are mainly satisfactory, but do not entirely comply with guidance and therefore do not provide service users with full protection. EVIDENCE: Service users informed the inspector that they would have no hesitation in speaking with either Mr Calder or Mrs Houghton if they had a concern. The complaints procedure is included in the home’s statement of purpose but there are minor shortfalls with regard to the content. The procedure does not inform the reader that a person may contact the Commission for Social Care Inspection at any stage of the complaint process and the incorrect name of the regulatory body is given. The home has adult protection, “whistle blowing” and responding to aggression/restraint policies/procedures. The wording of the adult protection procedure is in need of amendment to make it clear that no investigation of an alleged abuse incident is investigated by the management prior to obtaining the approval of an officer from Social Care and Health. In discussion with the inspectors staff members demonstrated some awareness of adult protection issues. Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19-26 Upgrading projects have improved fire safety levels at the home but the lack of some routine fire precaution measures mean that service users are not adequately protected. The rooms and areas that are accessed by service users are light, clean and odour-free, providing a pleasant and comfortable environment for service users. The lack of radiator guards in some areas and very hot water temperatures pose a potential risk to service users. Laundry facilities are sufficient to provide service users with clean clothing and linen and meet service users’ expectations. EVIDENCE: Upgrading work has been undertaken since the previous inspection to improve the fire safety of the building: fire doors have been fitted with swing-free closers, electronically linked to the alarm system, which means that service users can have their bedroom door open without compromising fire safety. A few of the routine fire precaution checks and measures have lapsed, including the training of some staff members. The home has still not arranged for the
Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 Page 16 testing of all portable electrical appliances. The fire risk assessment should also be reviewed at least annually to ensure that it includes all relevant aspects and accurately reflects the present situation. The inspector saw all communal rooms and areas and a sample of bedrooms. The accommodation is generally well maintained and is suited to the needs of service users who are currently living at the home. Service users have specialist equipment and items of furniture that they require to maintain their independence and they can access the patio areas and garden. An unsigned comment card was received at the Commission’s office, indicating an “urgent” need for wheelchair access to the front door. Whilst it is the case that there is a shallow flight of steps between the front patio and the car park which would have an impact on a wheelchair user it would appear that there is no-one currently living at the home whose mobility is adversely affected by this arrangement. The service users are happy with the lay-out of their bedroom and the items of furniture contained within it. Bedrooms have sufficient light, they are well ventilated and stay warm in cold weather. Bedroom doors do not contain the type of lock that is recommended under this standard that would enable them to lock their door from outside. Service users are given the option of an alternative lock following admission. Bathrooms and WCs have the necessary aids to enable service users to use facilities safely. The communal rooms are light and comfortably furnished. All areas of the home were found to be clean and free of unpleasant odours. Service users informed the inspector that their bedroom was kept clean and their bed linen was changed regularly. Service users said that their clothes were laundered efficiently and that items did not go missing. The laundry room is kept in good order and contains machinery which is suitable for the purpose. It is not ideally situated, adjoining the kitchen, but staff members take precautions to safeguard hygiene standards. The home is centrally heated with radiators in all areas accessed by service users. Radiators do not have covers or low heat surfaces. The manager has established which radiators present a high risk to service users and the intention is to implement a programme to address this issue. The hot water to outlets accessed by service users (baths and wash-hand basins) is very hot and there are no fail-safe devices limiting the temperature to forty-three degrees centigrade. The home’s policy is for staff members to run the bath water and check the temperature before service users enter the bath. There are risk assessments in service users’ files regarding radiator and hot water matters but they are not sufficiently robust and do not consistently take account of communal areas to which service users have access. Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The stable and well-motivated staff group ensure that all duties at the home are carried out efficiently. EVIDENCE: Staff members are employed in sufficient numbers by day and night to carry out the care, domestic and catering duties in the home. Staff members informed the inspector that they worked well together as a team and supported each other. A roster is in place which records staff cover each day; a record of the hours worked by staff members is kept in the diary. Service users confirmed to the inspector that their needs were met with the staffing arrangements that are in place. Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 There is an open style of management at the home which enables service users and staff members alike to feel confident about raising issues. EVIDENCE: Service users are able to raise issues with either Mr Calder or Mrs Houghton whenever they wish to. There are opportunities to discuss matters of mutual interest which affect the running of the home at any time. Service users like the informality of relationships that exist both between themselves and between themselves and staff. They take an interest in each other’s welfare and think of Garden House as their own home. This positive impression is confirmed in the results of a recent service user questionnaire carried out by the home in which all service users commented favourably on all aspects of the home. Staff members have confidence in the management; they are able to share ideas and to discuss issues as they arise. Formal staff meetings take place twice a year and a record is kept.
Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 1 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 4 14 2 15 3
COMPLAINTS AND PROTECTION 2 3 3 3 3 2 1 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x 4 x x x x x x Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 Page 20 Yes Are there any outstanding requirements from the last inspection? 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 1 Regulation 4&5 Requirement The statement of purpose and service user guide must be amended to comply with regulations. A copy of the revised documents must be sent to the Commission and be supplied to each service user and/or their representative. Previous timescales not met, most recently 31/5/05. Evidence of consultation with the service user and/or his/her representative must be documented with regard to the care plan. Where it has not been possible to achieve this, a note to that effect should be included in the record. Previous timescales not met, most recently 31/5/05. The registered person must make arrangements to ensure that medicines are given as prescribed and accurately recorded, and there should be a system for regular audits of medication. The home must keep records of the quantities of all medicines received. A risk assessment must be Timescale for action 31/10/05 2. 7 14(2)(b) 15(1)(2) 31/10/05 3. 9 13(2) 7/10/05 4. 5. 9 9 17(1)(a) 13(4) 7/10/05 31/10/05
Page 21 Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 6. 16 22 7. 19 23(4) 8. 19 23(4) 9. 19 23(4) 10. 25 13(4) 11. 25 13(4) recorded for each service user who is self-medicating. The complaints procedure must include the correct name of the regulatory body, Commission for Social Care Inspection. The registered person must arrange for the checking of all portable electrical appliances by a suitably qualified person. Previous timescales not met, most recently 30/4/05. All night staff members must receive fire instruction at quarterly intervals and all day staff at six monthly intervals. The record of instruction must include the topic covered and the name of the trainer in addition to the length of the session. Visual checks to hand-held firefighting equipment must be carried out each month and a record kept. Risk assessments conducted in respect of hot water temperatures must be sufficiently comprehensive and up-to-date to take into account the circumstances of service users, including communal areas to which they have access. The risk assessments with regard to radiators must be kept under review to reflect the changing circumstances of service users. Where there is a significant identified risk to the safety of service users remedial action must be taken. The timescale set for the requirement (30/9/05) had not expired at the time of the inspection; a new timescale has been set for implementation. 31/10/05 31/10/05 30/11/05 31/10/05 3/11/05 31/12/05 12. 13.
Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 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 1 Good Practice Recommendations The service user guide should include the address and telephone number of the Commission and of the local Social Care and Health office. This recommendation is made for the second time. The registered manager should improve the medicines policy for the home to include full procedures for the administration and handling of medicines (see guidance provided). The medicine record chart used should be reviewed and improved, and should included details of any medicine sensitivity or ‘none known’. If medicines are handwritten on the MAR chart a second trained carer should check them and countersign to confirm that the details are correct. Arrangements for the safe storing and handling of controlled drugs in accordance with the guidance from the Royal Pharmaceutical Society should be put in place. This recommendation is made for the fourth time. Information regarding service users accessing their personal records in accordance with the Data Protection Act 1998 should be included in the service user guide. This recommendation has been amended to reflect that it has been partially addressed and is made for the third time. The complaints procedure should inform the reader that he/she can make direct contact with the Commission at any stage of the complaint process and state the timescale within which the complaint will be investigated. The wording of the adult protection procedure should be amended to make it clear that no investigation of an alleged abuse incident is investigated by the management prior to obtaining the approval of an officer from Social Care and Health. This recommendation is made for the second time. The fire risk assessment should be reviewed at least annually to ensure that it includes all relevant aspects and that it reflects the situation and practice in the home. The registered persons should commence a programme of
D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 Page 23 2. 9 3. 9 4. 9 5. 14 6. 16 7. 18 8. 9. 19 24 Garden House 10. 25 11. 31 12. 13. 15 fitting the type of bedroom door lock which enables service users to safely lock the door from both sides, by means of a key on the outside (providing staff with access by means of a “master” key in case of an emergency). This should commence as bedrooms become vacant. All bedrooms should include lockable storage space. This recommendation has been amended and is made for the second time. A programme to fit guards to radiators and to limit hot water temperatures to 43 degrees centigrade at hot water outlets to baths and wash-hand basins should be implemented. This recommendation has been amended and is made for the second time. The responsible individual should compile a job description for the manager. The manager should check with the awarding body to ascertain if her qualification also equates to NVQ level 4 in care. This recommendation was not reviewed at the inspection and is carried forward to the next inspection. The record of meals provided should be amplified to better demonstrate the range of items offered. Garden House D55 S26807 Garden House V247624 310805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole Dorset, BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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