CARE HOMES FOR OLDER PEOPLE
Green Gables 6 Northdown Avenue Cliftonville Margate Kent. CT9 2NL Lead Inspector
Christine Grafton Announced 06 and 07 July 2005 09:50 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. Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Green Gables Address 6 Northdown Avenue, Cliftonville, Margate, Kent. CT9 2NL 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) 01843 227770 Miss Annette Smith Care Home 18 Category(ies) of Older People registration, with number of places Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: The home may from time to time admit persons between the ages of 60 and 65 years of age. Date of last inspection 10/3/2005 Brief Description of the Service: Green Gables is a detached three-storey property, providing 14 single bedrooms and 2 doubles. Five of the single bedrooms have ensuite facilities. There are stair lifts to the first floor and second floor. All bedrooms have a call bell point and television point. There are three lounge areas and a dining area, all of which are interlinked. One lounge area is known as the quiet lounge, where smoking is allowed. Green Gables is situated in a residential part of Cliftonville, close to shops and other local amenities. There is unrestricted parking on street, with one off-street parking place. There is a well laid out back garden accessible to residents. The registered providers, Annette Smith and Carol Lewis, have run the home since August 2003. Both work full time and they are assisted by a team of carers who cover care, domestic and cooking duties, including two senior carers who cover when the registered providers are off duty. The staff team work a rota that includes one carer on waking duty at night and one carer sleeping in. According to its statement of purpose, Green Gables aims to provide a home from home environment to meet the needs of elderly service users within its care. Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over a day and a half, plus a brief return visit was made for feedback. The total time spent at the home was 12 hours. Additional time was spent in preparation and report writing. The inspection consisted of speaking with the registered providers, staff on duty and eight residents individually. Records were seen and an accompanied tour of the building was made. The inspection focussed on checking the majority of the key standards. As part of the pre-inspection process, the registered providers completed a pre-inspection questionnaire and self-assessment, which provided valuable information, elements of which were checked during the inspection. As part of the pre-inspection process, residents and relatives were consulted for their views of the home. Nine relatives and sixteen residents returned their comments cards. All contained positive comments about the home. At the time of this inspection there were 18 residents. The care of six permanent residents, plus two residents staying for respite periods, was case tracked. The outcome of this inspection indicates that the registered providers are committed to providing a good quality service for residents and they are actively working towards meeting all aspects of the standards, within the space limitations of the building (which is a pre-existing home). What the service does well:
The registered providers have devised an informative service users’ guide, which is regularly reviewed and updated. This contains lots of information about the home and is given to all prospective residents before they move in. The admission process encourages trial visits to test drive the home, to see if it matches the person’s expectations. A resident spoke of this as a very positive experience. Green Gables provides a homely environment for residents and has a warm and friendly atmosphere. Commendable standards were apparent with regard to standards 19 and 32, relating to the maintenance of the environment and the ethos of the home. The home is comfortably furnished and pleasantly decorated. There is a commitment to staff training and development. This has created an enthusiastic workforce that is well motivated and works positively with residents to ensure that all their health and welfare needs are met. Good care
Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 6 practices were observed in the way that staff interact with residents and give discreet assistance that respects dignity. Residents benefit from a range of activities organised by an activities co-ordinator, who spends two hours a day at the home during the week. Care staff provide additional stimulation to residents by sitting and talking with them about current affairs and other matters of interest to them. What has improved since the last inspection? What they could do better:
Care plans are in place, but need to be more detailed to make sure they contain all the information necessary for staff to provide the appropriate care to meet residents’ health and welfare needs. The addition of a dependency assessment tool, together with skin integrity and nutritional assessments, would, if properly completed, encourage staff to make sure that vital healthcare needs are not overlooked in the care plans. This would also provide evidence of good practice and safeguard residents’ welfare. Risk assessments need to be further developed to ensure they are individual to the person. Self medication assessments should include details of all current medications for safety. An appropriate hand drying facility (such as paper towels) needs to be provided in the ground floor toilet off the dining room, so that residents who use this toilet unassisted, can safely wash and dry their hands, to prevent the spread of infection. Staff recruitment procedures need reviewing and action is needed to ensure that staff criminal record bureau checks (CRB) and references are obtained prior to new staff starting work at the home. Reference request letters need to be improved to ensure they contain sufficient information. Where a staff
Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 7 member starts work following a protection of vulnerable adults (POVA) list first check, but before the return of the CRB check, procedures must be put in place to ensure they are properly supervised and records kept to evidence how this is being done. This is necessary for the protection of residents. Bedroom fire doors must not be wedged open, as this is a fire safety risk. If bedroom doors need to be kept open, they should have appropriate devices fitted that safely keep the doors open, but close automatically when the fire alarm sounds. This action is necessary to ensure residents’ safety. 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. Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 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 Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 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, 2, 3, 4 & 5 Green Gables admission procedure ensures that prospective residents have all the information they need to know to make the decision about moving into the home. This includes the opportunity to make a trial visit to test the quality of the home and service provided. The assessment process is very thorough and makes sure that the person’s needs can be met at the home. The home can demonstrate through its records, practices and staff competency that it can meet residents’ needs. EVIDENCE: The statement of purpose and service users’ guide provide a real ‘flavour’ of the home. Residents are given their own copy of the service users’ guide and there is a copy readily available in the dining room. The service users’ guide had been reviewed, updated and contained accurate information. A resident’s contract was seen to contain all the appropriate terms and conditions of residence and had been signed by both parties to the agreement. From the case tracking, it was clear that the registered providers had carried out comprehensive needs assessments, both prior to and following admission Strategies had been put in place to address any risks identified. The documentation seen contained all the components specified in the standards.
Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 10 A new resident was spoken to in private and said that relatives had “looked round several homes and fell in love with this home – we’ve found a little paradise for you.” The resident went on to say, “I entirely agree. I liked it very much when I came for a day’s trial stay.” The resident felt the home provides value for money, s/he was given a “brochure” to weigh it up, had a free lunch at the trial visit and said, “the food is very good, staff are top class – very helpful, very good.” Another resident said, “I feel safe here.” Since the last inspection, the registered providers contacted the commission about admitting a resident under 65 years of age. They applied for a variation to their registration, which was granted, as their track record shows that they consult with the commission if there is any doubt as to whether a prospective resident’s needs can be met within the home’s registration. From the case tracking, a situation was discussed that might indicate the need for a variation to the registration, where a resident is showing signs of dementia. The registered providers were in the process of consulting with the general practitioner and other health care professionals. They agreed to inform the commission of the outcome within a specified timescale. Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Care plans provide staff with most of the information necessary to ensure that the residents’ health, personal and social care needs are met. Some aspects of the care plans need to be developed to ensure that information known to staff verbally is not lost. Personal and health needs of residents are being met, but how this is being achieved is not always clear in the care plans. Improvements have been made to the medication storage to improve safety and residents’ medications are on the whole well managed. Personal care is given in a manner that protects residents’ privacy and dignity. EVIDENCE: From the case tracking of the care plans, it was clear that residents’ identified needs have been incorporated into their care plans, which provide some useful information. Detailed care plans had been drawn up by the registered providers at last year’s announced inspection in September 2004 and although records indicate regular reviews, information has not always been added in sufficient detail as needs have changed. The registered providers have spent their time on making other improvements to the home during the past year, so they have tried to develop the care staff to write the care plans. Some care plans had missing elements, such as: personal profiles, dependency assessments, skin integrity assessments and nutritional assessments. There was a lack of sufficient information regarding catheter care for one resident,
Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 12 management of incontinence and on how verbal aggression was being dealt with in one case. Some of the staff have worked at the home for a number of years and know the residents’ needs well. Residents confirmed that staff provide assistance in the way that they prefer. A resident spoke about their care needs and said “It is excellent here, I wouldn’t wish to be anywhere else. Staff are always kind.” The home works closely with health care professionals, such as the community nurses, doctors and care managers, to ensure that resident’ best interests are protected. This was evident in the care plan records and from discussions with the registered providers, residents and staff. Specialist equipment is provided where necessary, such as pressure relieving mattresses and cushions. Medication storage has been reviewed since the last inspection and changes made to provide a dedicated lockable medication cupboard, with separate metal lockable unit within, for storage of controlled drugs. There is a separate dedicated medication fridge. A new trolley has been purchased for use specifically when staff administer the medications. A resident’s self medication assessment did not include all of their current medications. The home does not have a controlled register. Ten staff have completed a distance learning medication course since the last inspection. Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 & 15 Residents are given the opportunity to take part in a range of meaningful activities. Social contact is encouraged, residents are enabled to maintain choice and as much control of their lives as possible, within their physical and mental capabilities. Meals provided are good, they are well balanced, varied and offer choice to meet residents’ tastes and needs. EVIDENCE: Residents spoke about their daily lifestyles and it was clear that routines are flexible, one resident said, “the way of life here is very good, you meet some nice people, it is very, very good, there are no silly restrictions.” Residents spoke about visits from their families and friends. An individual outing was arranged on one day of inspection, so that a resident could take their dinner with them when going to visit a sick relative. An activities co-ordinator spends two hours a day at the home on weekdays. The times are varied and activities provided are both group and individual. The activities co-ordinator plans the activities with residents, records activities and who has participated. During the inspection, a group of residents were taking part in a quiz. There is a four week menu plan that shows two choices for the main meals and a variety of choices for breakfast. The dinner on day one of the inspection was chicken supreme or toad in the hole. A staff member was seen going round in the morning asking residents what they would like. Several residents spoken to said the food is very good.
Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 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 Residents know that their complaints will be listened to and acted upon. Complaints records could be improved. EVIDENCE: Residents spoken to said they had no complaints and know how to make a complaint. The complaints procedure is displayed on the back of each bedroom door, as well as in the entrance hall and within the service users’ guide. The notice clearly states details of how to contact the commission and this is also included in the residents’ contract/statement of terms and conditions of residence. Records of complaints are kept and the last one recorded was on 15th October 2004. During discussion with a resident it transpired that a complaint had been made about the time taken for clothing to be returned after laundering and of items returned that did not belong to them. The resident confirmed that it had been responded to and that the registered providers had resolved the problem. This had not been recorded as a complaint. Residents are also enabled to air any concerns at residents’ meetings. Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 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, 20, 21, 22, 23, 24, 25 & 26 The programme for improvements to the building, fabric and decoration of the home, identified in the home’s business plan, has been achieved and exceeded. The changes made have added to the homeliness, comfort and safety of the home and offer a very pleasant environment for residents to live in. Infection control procedures were generally satisfactory, but hand drying facilities need to be improved in one area to ensure safe hygiene. EVIDENCE: A number of improvements have been made since last year’s announced inspection, including: a new stair lift to the first floor, a new banister rail to the top floor, a new boiler, a new washing machine and paving of the front garden, with a slope to the front door, instead of a step, making easier wheelchair access. Four more bedrooms have been redecorated to a high standard, with colour coordinated curtains, bedspreads, lampshades and radiator guards. A new vanity unit has been fitted in one bedroom, plus four new commodes and ten new over-bed tables have been purchased. A new conservatory is being built to provide an additional, separate area to be designated for smoking. All these improvements plus, the changes to medication storage already
Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 16 mentioned, have significantly improved the environment and safety for residents. Liquid soap and paper towels have been provided in areas where soiled articles and clinical waste are handled, but there were no paper towels in the toilet adjacent to the dining room. The registered providers explained that staff take these in with them when they assist residents, but paper towels are not left in there, as residents had been flushing them down the toilet, causing blockage problems. They agreed to consider other options discussed to ensure that safe infection control standards are available when residents use the toilet unaided. Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 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, 28, 29 & 30 Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. Sufficient numbers of staff are on duty and deployed in a way that meets residents’ needs. Recruitment procedures need to be tightened to ensure that residents are fully protected. There is a commitment to staff training and staff demonstrated their knowledge of good practice principles in their actions and conversations. EVIDENCE: The registered providers are using the Department of Health guidance to calculate the ratios of care staff on duty to meet residents’ needs. A copy of their calculation was seen, discussed and assessed as appropriate. The system could be improved by adding a dependency assessment tool to the care plans, but evidence seen indicates that staffing numbers on duty were sufficient. Rotas were seen showing the hours worked by staff. In addition to the staff allocated for care, there are designated staff on duty for cleaning, cooking and activities. Six care staff have completed their National Vocational Qualification (NVQ) level 2 in care. Three staff induction records were seen to cover all the Skills for Care criteria. The staff training matrix indicates a varied training programme, including infection control training, which nine staff have completed, plus other courses referred to throughout this report. Four staff files were checked and included application forms, photographs, proof of identity, references and job descriptions. Criminal records bureau (CRB) checks have been obtained for existing staff, but six new staff who had
Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 18 been employed within the last six months, had started work prior to receipt of their CRB checks. Where protection of vulnerable adults (POVA) list first checks had been made, it was not evident in the records that they were being properly supervised. One staff file contained only one reference and some references seen were dated after the person had started work. Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 19 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) 31, 32, 33, 35, 36, 37 & 38 The two registered providers, between them, have the experience, competency and qualifications to run the home in a way that meets its stated aims and objectives. They have a clear vision and development plan for the home, which is effectively communicated to residents and staff. Staff have a good understanding of their roles and responsibilities and residents and staff are able to influence how the home is run. Records are well kept and safeguard residents’ rights and best interests. Systems are in place to protect residents’ financial interests. The health & safety of residents and staff is promoted but action is needed to ensure that all fire doors will close when the fire alarm sounds. EVIDENCE: One of the registered providers has achieved her National Vocational Qualification (NVQ) level 4 in management and care and the other provider has an NVQ level 3 in care. Both have attended a variety of short courses to
Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 20 regularly update their knowledge, skills and competence. They each have clear roles and responsibilities for the management of the home. The atmosphere in the home was relaxed and unhurried. Residents praised the way the registered providers run the home, saying that they are open to suggestions and always happy to listen to them. They value the regular daily contact with both providers. The registered providers work along side the staff and help out ‘on the floor’ when needed. Staff spoken to were committed to their jobs and to providing good care for the residents. A staff member said s/he likes working at the home. A relative’s comment card stated, “I like the friendly atmosphere at Green Gables and the cheerfulness of the owners and staff” another stated, “The staff are all most friendly and helpful”. The home’s quality monitoring systems include regular staff meetings, formal staff supervision, residents’ meetings and questionnaires. Minutes of the last residents’ meeting held prior to this inspection indicated that the inspection had been discussed, plus plans for the new conservatory. Other issues included ideas for an outing, food preferences and various other comments showing that residents’ views had been sought. The system for dealing with residents’ monies was checked and seen to include secure storage, good records, photographs of each resident and signatures, indicating that residents’ financial interests are safeguarded. The fire safety log book was seen. This had been reviewed and updated and a fire risk assessment completed. Good records of weekly and monthly checks were being kept and it was seen that the required fire drills take place. On the tour of the building, there were a number of bedroom fire doors that were wedged open. Staff training records indicate that twelve staff undertook fire safety training on 26th April 2004 and eight staff completed moving and handling training on 19th April 2005. Records also indicate that training is ongoing and that sufficient staff have been trained in first aid, food hygiene and health and safety. Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 21 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 3 3 3 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 4 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 3 4 3 x 3 3 3 2 Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 22 NO 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 OP4 Regulation 12 Requirement Timescale for action 31/8/2005 2. OP7 3. OP8 4. OP9 5. OP26 The registered persons must ensure that the home is complying with its registration category (in relation to a resident with signs of dementia). Appropriate action must be taken to ensure that the needs of the resident discussed comply with the homes registration. 14 & 15 Care plans must set out in detail the actions to be taken by care staff to meet residents needs. Review records must be sufficiently detailed. 12, 13, 14 Care plans must include & 15 dependency assessments, skin integrity assessments, nutritional assessments and risk assessments to be more individualised. 13(2) Residents self medication assessments must include all current medications. A controlled drugs register to be obtained. 13(3) Appropriate hand washing/drying facilities must be in place and regularly topped up where clinical waste is handled. (This refers specifically to the ground floor toilet off the dining room).
H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc 30/11/05 30/11/05 30/9/2005 31/8/2005 Green Gables Version 1.30 Page 23 6. OP29 19 7. OP38 23(4) New staff must not be employed 31/8/2005 unless they are fit to work at the care home and information is obtained as specified in Schedule 2. Recruitment procedures must ensure that gaps in employment are checked out, appropriate references obtained and CRB/POVA checks are carried out for all employees prior to their start date. Where an employee starts work after a POVA first check, before return of the CRB, they must be properly supervised as specified in the Miscellaneous Amendments Regulations 2004 and records kept. Fire doors must not be kept 31/8/2005 wedged open, doors that need to be kept open must have suitable closures fitted that will automatically close in the event of a fire. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP16 OP27 Good Practice Recommendations To ensure that all complaints, no matter how trivial, are recorded with the outcomes. That the hours worked by the registered providers to cover care shifts for sicknes/absence are recorded on the rotas. Residents individual dependency assessment tools to be developed to inform staffing calculations. Green Gables H56-H05 S47327 Green Gables V229539 060705 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent. TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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