Inspection on 10/05/05 for Green Heys

This inspection was carried out on 10th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Green Heys 15/06/09

Green Heys 29/11/07

Green Heys 09/08/06

Green Heys 03/11/05

Green Heys 09/09/04

Green Heys 19/05/04

Green Heys 07/03/04

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

CARE HOMES FOR OLDER PEOPLE Green Heys Park Road Waterloo, Liverpool Merseyside L22 3XG Lead Inspector Julie Garrity Unannounced 10th May 2005 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 Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Green Heys Address Park Road Waterloo Liverpool Merseyside L22 3XG 0151 949 0828 0151 949 8967 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) Community Integrated Care Mrs Susan Frances Kelly Care Home 47 Category(ies) of Dementia - 10 registration, with number Mental Disorder - 47 of places Dementia Over 65 - 10 Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to a maximum of 47 DE(E), of which up to a maximum of 10 DE and up to a maximum of 10 MD. 2. Manager to be supernumerary at all times. 3. Training with regards to challenging behaviour for all staff involved in the careof the 10 service usres under the retirement age. 4. That a robust activities and personal development plan per individual be utilised for the 10 service users under retirement age and that an allocated individual be available to co-ordinate the above. 5. Suitably qualified, experienced and skilled staff in the care of individuals with a learning disability be employed to deliver suitable care for any of the 10 service users under retirement age who are diagnosed with a learning disablility 6. Service users under retirement age are to be no younger than 50 years of age. Date of last inspection 9th September 2004 Brief Description of the Service: Green Heys is a Care Home with nursing care. In total the Home provides care for 47 service users over retirement age. There are 10 places available for residents aged 50 and above. The Home cares for individuals with mental health needs. The area close to Green Heys is residential, there is a local library within walking distance and a number of shops. The main shopping centres of Liverpool and Crosby are accessible by public transport. Public transport is approximately 5 minutes walk away. Green Heys is a privately owned establishment, the owners are a charitable organisation with a number of establishments in the North West catering for a variety of residents needs. The Home is purpose built on 1 level and all areas are accessible by residents. There are 34 single rooms, all with en-suite facilities, and 4 double rooms, all with en-suite facilities. There are gardens to the side and rear of the Home. There is 1 main dining room and 3 day rooms. Green Heys has a central enclosed courtyard accessible by the resident. Parking is available to the front and the side of the building and there are main travel routes that provide easy access to the area that the establishment is situated. Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 9.45 am on the 10/05/05 the duration of the inspection was seven and a half hours. Mrs Helen Cook represented Green Heys throughout the inspection. Due to the nature of dementia relevant conversation with residents is not always possible. For this inspection it was essential that the majority of information came from relatives, staff and the homes records. Although seven residents were spoken with the conversations were brief. Four relatives, ten members of staff and the manager engaged in discussion. Resident and relative questionnaires were left in the Home, however none were returned. A variety of records in the Home were viewed and a tour of the Home was undertaken. What the service does well: What has improved since the last inspection? What they could do better: A new manager has been recruited and the manager must submit an application to CSCI for registration. Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 6 Staff rely heavily on their verbal communication and the perception that they understand the residents needs. This has lead to a paternalistic attitude in which many decisions are taken for residents based on insufficient information. It is essential in order to promote residents’ independence those opportunities to determine residents personal choices are increased. A number of records in the Home are not appropriately maintained and vital information needed to make sure that a quality service is delivered is missed. These include care plans, records regarding residents choices and social needs, staff training and checks prior to working in the Home and care staff Supervision. Of particular concern is the giving, recording and storage of medications. A number of serious errors were noted. The management of medications is a concern and it is imperative that steps are taken to manage medications safely and in accordance with current legislation. The manager will need to make sure that all records within the Home are kept up to date and that staff receive proper formal supervision on a regular basis. The Home has poor appearance with many areas appearing dirty, despite excellent efforts made by cleaning staff. Furniture is worn and damaged, corridor carpets are stained, some bedrooms are unwelcoming and some areas of the Home contain offensive smells. Health and safety needs to be improved. The practice of wedging open fire doors open must cease and the fire officer’s recommendations implemented. Short stay residents (respite) are not assessed before they are admitted to the Home and the staff are not fully aware of the needs of these residents. Staff must have a clear understanding of the residents needs prior to admission in order that the staff can care appropriately for the resident. 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 Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2, 3, standard 6 is not applicable as the Home does not provide intermediate care. The home has a good assessment process for the majority of residents. A lack of an assessment for respite residents puts them at risk of receiving inappropriate care. Because of a lack of information available for residents before they are admitted residents are not in a position to make an informed choice about the care that the home provides. Contracts are good, but would benefit from being available in formats more easily readable by residents or their representatives. (could do better section) EVIDENCE: The Statement of Purpose and Residents Guide are not available. Resident contracts are available in these detail the services that the home will provide. Thorough assessments were availiable for most residents undertaken by nursing staff prior to admittance. The exception to this concerned those residents admitted for respite care. Information prior to admittance is not always made available to the Home nor does the Home take steps to obtain this information. The staff in Green Heys explained that the lack of information has on occasions prevented them from delivering appropriate care. Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9, 10 Although Individual care plans are availiable for each resident, they are complex and out of date. Staff were observed to treat the residents with dignity and respect .The barn like bedroom doors that some residents have do not support residents in their dignity or privacy being maintained. The current arrangements for receiving, storing and giving medications are unsafe and place the residence at risk of receiving incorrect medication. EVIDENCE: Care plans contain a lot of useful information. Four of the care plans were very detailed, however two others care plans did not fully explore the care needs of the residents. Of the care plans viewed several had not been updated recently and repetitive. This results in care plans that are not easy to read and are therefore not accessible by residents or their representatives. A CSCI pharmacy inspector reviewed the medications. There were a number of concerns raised, these included, the inaccurate recording of medications given to residents, the inaccurate recording of medicines received in the home, medications are not given in accordance with the prescriptions and the lack of awareness by a staff member as to the availability of important records. Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 10 Relatives said that they felt the staff spoke appropriately to residents at all times. The staff were observed to speak politely and with consideration to the residents. Of concern is the usage of barn door like bedroom doors, the top half of which remains open at all times. Residents can be viewed in bed from the main corridor this does not maintain the dignity of the resident in the bedroom. Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 11 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 contact with relatives is supported appropriatly. Staff have effective personal relationships with residents and their families. There is some excellent information regarding resident’s social needs and daily choices. Staff have a tendency to make decisions for residents less able to voice their choices. Decisions are made without consultation of residents which is poor practice. EVIDENCE: Staff on duty demonstrated genuine warmth in their dealings with individual residents and their relatives. It is the nature of dementia that communication with residents is not always easy in particular in determining their choices. It is unfortunate that this aspect has not been fully explored with the residents and their relatives. Staff have very good verbal communication skills and said that they know what the residents want. Subsequently many of the residents choices are not determined or put into place. This reliance on verbal discussions will compromise residents choices if the verbal discussions breakdown. Different activities are available and a number of residents join in these. There is a tendency that the same residents go on trips out and little consultation is taken with other residents. One resident spent the majority of their time in their room, this was happening as staff felt the resident was “noisy” and upset other residents. Little opportunity had been taken to explore the reasons for Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 12 the individual’s agitation. The room was plain, with no stimulation. Another resident’s bedroom was observed to have lots of different lights, music and a television. This had been supplied by the resident’s relatives. Residents spoken with said the food was of reasonable quality. Resident’s menus detailed a choice, in general the decision for many of residents as to which food that they would like to eat that day was made by the staff. On the day of inspection residents were receiving tinned fruit after their main meal. This had been liquidised for all the residents, it was explained that this done in order to prevent residents who required their foods liquidised from accidentally accessing unsuitable fruit. This decision was taken without consultation with residents and is poor practice. The menu board outside the dining room did display accurately the meals available that day. However the writing on the board was very small and would be unreadable to residents with poor eyesight or confusion. Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 13 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) 16,18 There is no complaints procedure available to residents and relatives. There was a lack of understanding and training for some staff in the proper response to any allegations or suspicion of abuse, although staff were able to appropriately state who they would report any potential concerns regarding protection of adults to.The protracted response times from the company who have carried out investigation of formal complaints is not satisfactory. EVIDENCE: A copy of the complaints procedure is not available in the home. The CIC head office investigation of formal complaints have not been dealt with within 28 days. There is confusion amongst the staff as to what constitutes a complaint or concern and precisely what approach is needed. There are a number of policies available regarding complaints and Protection of Vulnerable Adults. Several care staff were able to clearly detail what actions they needed to take if they suspected an allegation of abuse. Staff training records were all on individual files and as such it was not possible to determine quickly or effectively if all staff have received training in this area. Two staff spoken with said that they had not received any training in this area. Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 14 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, 21, 26 Green Heys Care Home is in need of refurbishment. The environment is not well maintained nor comfortable. Bathroom facilities are dated and do not present a welcoming environment. Furnature is damaged and presents a safety risk to residents. EVIDENCE: There are plans to extensively redecorate and refurbish the Home. Residents and relatives said that in their opinion the home appeared poorly maintained. The main corridors carpets are badly strained, as are the carpets in the lounges. Although some of the bedrooms have been redecorated, the majority remain poorly presented. There are several areas within the home that have offensive smells. This includes three bedrooms and some areas in the main corridor. The majority of the furniture in the home is damaged and worn. Bathroom facilities are clinical in appearance and have no access to natural light. There are no shower facilities available within the home, two residents spoken with said that they would like a shower. The cleaning team tries very hard to keep the home clean and hygienic. This is not always possible due to poor maintenance within the home and damage to the carpets and furnishings. Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 15 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, 29 30 On the day of inspection there was sufficient staff available to meet the needs of residents with the exception of mealtimes. The reliance upon staff to report if they feel over worked is not an effective way to ensure that resident’s needs are met. The poor record keeping does not assist the manager to be confident that all staff have been recruited appropriately or have received suitable training in order for them to be able to carry out their duties. EVIDENCE: Resident’s relatives and staff said that there is sufficient staff available. There is a high staff turnover, and some vacancies can take several months to fill. Regular agency staff are used to assist in maintaining staffing levels. However as the Home does not monitor the staffing levels it is not possible to determine that there is sufficient staff available to meet the needs of the residents. Mealtimes were very busy staff were unsure as to whether all the residents had received their meals. Other staff were having their own dinner breaks or attending to other residents, this reduced the amount of staff available to serve, monitor and assist residents at meal times. Staff described a variety of training that is undertaken, however it was not possible to confirm that all staff have received appropraite training. Staff training records were not updated and there is no training plan that could clearly identify what training staff need to undertake to meet the residents needs. Two staff explained that they had not completed their induction training and were unsure as to what training they needed to undertake their job role. Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 16 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) 33, 36, 38 A good quality assurance assessment has been undertaken from which the manager will be able to plan the ways to build on the strengths of the Home and to address any shortfalls. Not all staff have received induction training or approprite supervision. There are Health and safety concerns that place residents at risk. EVIDENCE: Green Heys has undertaken an external quality assurance assessment from an external company known as RDB (Residential Domicillary Benchmarking). The Home achieved 3 stars in a 5 star scheme. The manager has reviewed this report and is in the process of building on the Homes strengths and minimising the weaknesses. A new manager has been appointed. Many of the residents, relatives and staff spoke very positively of the new manager and were confident that she would be able to support the staff in improving the quality of the Home. Staff have not received formal supervision for over 6 months. As the senior staff do not work along side care staff informal supervision also does not occur. Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 17 PIN checks for qualified nursing staff that make sure that they were qualified to undertake their role were not available. Although a number of other checks for experience and qualifications was available. There were no records that checks had been undertaken for temporary agency staff or that they received any form of induction into the Home. Fire records demonstrated that alarm tests and drills were up to date. Six bedroom doors were inappropriately propped open. These present a serious risk in preventing the spread of fire should it occur. Risk assessment were confusing and in some instances were not available. Although accidents within the home had not been monitored the sometime this has since commenced and has assisted in identifying those residents most at risk. Bathing equipment that was not suitable to the needs of all residents. Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 18 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 1 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 1 x 2 x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x 3 x x 2 x 2 Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 19 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 OP1 Regulation 4 (1) (a) (b) (c) (2) Requirement A Statement of Purpose and Service Users Guide must be available and a copy forwarded to the Commission.(Outstanding from previous report) The manager must ensure an accurate record is made of all medicines received into the home The manager must ensure unwanted medicines are stored and disposed of safely and accurate records are made. The manager must ensure an accurate record of all administered medicines is made. The manager must ensure the pharmaceutical fridge temperature remains in the range 2°C to 8°C. The manager must ensure all medicines are administered as prescribed and are used within their expiry date. Due to the usage of “Barn” type bedroom doors all staff must be aware of the impact of this on service users dignity and ensure that doors do not remain open whilst service users are at rest. Timescale for action 10/08/05 (Timescale extended from previous report) 17/06/05 2. OP 9 12 (3) 3. OP 9 12(3) 17/06/05 4. 5. OP 9 OP 9 12 (3) 12 (3) 17/06/05 17/06/05 6. OP 9 12 (3) 17/06/05 7. OP 10 12 (4) (a) 10/05/05 (as agreed at inspection) Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 20 8. OP12 12 (2) 9. OP 16 22 (3) (4) (outstanding from previous report) Staff must be made aware of the importance of service users individual choice in particular for those less able to vocalise their choices. (oustanding from previous report) All complaints must be fully investigated and addressed with 28 days. (outstanding from previous report) A programme of refurbishment must be forwarded to the Commission.This must include the appropriate bathing facillities. (Outstanding from previous report) All staff training records must be reviewed to determine what training staff have recived, any gaps in training and arrangemenst made to make sure all staff the training that they need in order to fulfil their job role. All staff must receive induction and foundation training in accordance with Homes policies. (Outstanding from previous report) The manager must make sure any staff working in the Home including temporay staff, work placement staff and students have proof of identity, qualifications, experience and a Criminal Records Bureau check as appropriate. An application must be submited for registered manager. All care staff must formal supervison 6 times a year. 10. OP 19 23 (2)(a) (b) (d) (j) 11. OP 30 18 (1) (a) 10/07/05 (timescale extended from previous report) 10/07/05 (Timescale extended from previous report) 10/07/05 (Timescale extend from previous report) 10/08/05 12. OP 30 18 (1) (c) (i) (ii) 13. OP 29 18 (1) (a) 10/07/05 (Timescale extended from previous report) 10/07/05 14. OP 31 8 (1) (a) (b) 18 (2) 15. OP 36 06/06/05 as agreed at inspection. 10/08/05 Page 21 Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 16. OP 38 23 (4) (a) Put in place the fire door magnetic closures as required from the Fire Authority. 17. OP 38 23 (4) (a) 10/06/05 (Timescale extended from previous report) The practice of wedging open fire 10/05/05 doors must cease. (as agreed at inspection) 18. 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 OP 1 OP 3 Good Practice Recommendations Information within the Home should be written in formates accessable to the residents. All respite residents should have an assesment either in person or via the telephobe before admittance. Additional information from the main carer, either a family member, private care deliver or social services should be sought and used as part of the assessment. The manager should be satisfied that the Home is able to meet the needs of the resident before admission takes place. Care plans should be simplified in order to ensure that they are accessible by service users and meaningful to the staff. Care plans should be individual and reflect the changing needs of care in all areas.The Manager should provide an index system for care plans, to aid ease of reference. All patient information leaflets should be obtained and presented to staff for training and information. A local procedure should be written describing all medication handling procedures within the home. All prescriptions should be seen prior to the pharmacist dispensing and this should be clearly evidenced. Non-prescribed medication should be recorded on the MAR and marked appropriately. Staff routines should be reviewed to ensure that service users choice is determined before routines are utilised. Review the arrangements for determining service users F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 22 3. OP 7 4. 5. 6. 7. 8. 9. OP 9 OP 9 OP 9 OP 9 OP 12 OP 14 Green Heys 10. 11. 12. 13. OP 15 OP 15 OP 26 OP 38 less able to convey their choices and likes and dislikes to fully develop a completed social assessment. The menu board should be larger and written in large handwriting so residents can read what meals are on offer. Food should not be liqiuidized for all residents. Offensive smells in the three bedrooms identified should be investigated and appropriate action taken. Risk assessments for falls/injuries and the usage of fire equipment should be regular reviewed. More frequently for those identified as being at greater risk and following an accident to determine if the actions and equipment in place remains suitable to the needs of the service user. Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Burlington House, South Wing 2nd Floor Crosby Road North Waterloo, Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Green Heys F53 F03 S17237 Grenn Heys V235213 100505 Stage 4.doc Version 1.30 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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