CARE HOMES FOR OLDER PEOPLE
Grenham Bay Court Grenham Bay Court Cliff Road Birchington Kent CT7 9JX Lead Inspector
Christine Grafton Announced Inspection 17th November 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Grenham Bay Court Address Grenham Bay Court Cliff Road Birchington Kent CT7 9JX 01843 841008 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) juliemills@highmeadow.co.uk Grenham Bay Care Ltd Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One resident whose date of birth is 17/10/1941 Date of last inspection 8th June 2005 Brief Description of the Service: Grenham Bay Court provides accommodation and care for older people. The home has 32 bedrooms, which are mainly used as singles, but there are 5 double sized rooms that can be used by people who wish to share. The majority of bedrooms are on the ground floor and most have ensuite facilities. There are a variety of lounge areas and there is a small garden to the rear. The home faces the sea in a residential area of Birchington, near Margate, within walking distance of most local amenities. The home has its own transport that can assist residents to access local shops and other places of interest in the area. There is unrestricted on road parking to the front of the property. Grenham Bay Court is owned by a private company that employs a manager who has the day-to-day responsibility for the home. Staff are on duty 24 hours a day, which includes a senior member of staff on all shifts during the day and two staff on wakeful duty at night. Senior staff are available on-call at night. Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over two days. 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 manager, 2 staff members, 11 residents and 1 visiting relative. Records were seen and an accompanied tour of the building was made. The inspection focussed on checking the requirements from the last inspection and some of the key standards. As part of the pre-inspection process, the registered provider completed a preinspection questionnaire, which has been used in the preparation of this report. Residents and relatives were also consulted prior to inspection for their views of the home. 11 relatives and 12 residents returned their comments cards, which mainly contained positive comments, but there were some issues raised that were followed up during the inspection. At the time of this inspection there were 26 residents. The care of 5 residents was case tracked. This was the home’ s third inspection since March 2005. There were 19 requirements made at that visit that had been reduced to 9 requirements by the time of the last inspection on 8th June 2005. The outcome of this inspection indicates that the management have worked hard to bring about the necessary improvements. Standards that were previously not met have now been either met, or almost met and the requirements made in this report are mainly to continue and build upon the improvements already made. What the service does well:
Residents are given the opportunity to take part in a variety of activities within the home. Routines are flexible and residents can choose to stay in their rooms for as long as they wish, or to socialise in the lounges if they prefer. The home provides the residents with a variety of communal areas that include a large main lounge/dining area, a second smaller lounge/dining area and two other quiet lounges. The communal areas are pleasantly decorated and furnished to create a warm homely environment. The majority of bedrooms are singles and most have ensuite facilities. Residents are provided with a well-balanced, varied diet and are given the option of two choices at dinner and tea times. Meals are unhurried and served in pleasant surroundings. Several residents commented that the food is good. Residents and staff commented on the nice atmosphere in the home. There were several comments that staff are kind, caring and friendly. A resident
Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 6 said, “It was the best thing I did when I moved in here, the staff are lovely and I have a lovely room.” A staff member said, “It’s brilliant working here, it is really good, they treat residents very good. I’m happy to work here.” What has improved since the last inspection? What they could do better:
Pre-admission assessments need to be sufficiently detailed to make sure that the home can meet the person’s needs on admission. Residents’ dependency assessments need to be completed and kept up to date, so that staffing levels can be properly calculated to ensure there are sufficient staff on duty for the residents’ welfare. Residents’ risk assessments must be sufficiently detailed and updated to make sure that all identified risks are recorded and have safety strategies in place for residents’ protection, such as: skin integrity and nutritional assessments. The practices for the cleaning of bedrooms need to be reviewed and any necessary action taken to make sure that bedroom carpets are kept clean throughout the week. Several bedroom carpets needed vacumming and a relative’s comment card contained a statement that the bedroom is not cleaned until late afternoon. This detracts from the homeliness of the rooms. Recruitment practices could be improved to ensure that the necessary safeguards to protect residents living at the home are properly in place. Police checks and checks against the protection of vulnerable adults register must be completed before new staff commence work at the home. Whilst the manager stated that this does happen, the correct information was missing from the staff files checked, so this could not be verified. The manager agreed to audit the staff files to make sure that everything is as it should be. Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 7 Records are generally well kept, but the management must ensure that proper records are kept of any monies held on behalf of residents. The home was holding some money for one resident and the manager agreed to start a record straight away. This is to protect the resident and the home, in case of dispute. 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. Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 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 the following standard(s): 1&3 The home’s statement of purpose and service users’ guide provide all the information for prospective residents to make a fully informed decision about moving into the home. The assessment process needs to be developed to show the decision-making process that ensures the person’s needs can be met at the home. It is not the general policy of the home to admit residents for intermediate care, so standard 6 was judged as not applicable at this inspection visit. EVIDENCE: The statement of purpose and service users’ guide provide the reader with a real ‘sense’ of the home. Copies of both documents are displayed by the visitors’ book in the entrance hall. Residents are given their own copy of a large print version of the service users’ guide, one of which was seen in a resident’s bedroom. The manager had recently reviewed and updated the statement of purpose. Two of the residents’ case tracked had been admitted to the home since the last inspection, one in July and one in October. Evidence was seen in one care plan indicating the pre-admission assessment process and the strategies put in
Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 10 place to address risk. The assessments for both residents provide some useful information, but documentation is currently being developed. It does not yet provide all the necessary information, for example, there were gaps in the new assessment format being used that did not provide a full picture of all care needs. Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9 & 10 Improvements seen at the last inspection in the home’s care planning system have been maintained. However, the care plans and healthcare records still do not provide staff with all the information they need to make sure that residents’ needs are fully met. Medication storage and practices have improved, but procedures need to be further developed to uphold safety. Residents are treated with respect for their dignity. EVIDENCE: The new manager has introduced a more simplified care plan format to make it easier for staff to follow. The new format has now been completed for all residents. Whilst the care plans seen contained some good information, some significant risks and care needs had either been left out, or were not covered in sufficient detail. For one resident case tracked, the records indicated there had been a past skin integrity risk, which had not been followed up. There was no personal hygiene section completed in the care plan and there was no nutritional assessment. Mobilisation had not been covered and there was nothing recorded to indicate whether the person walks unaided, with a walking stick, or uses a walking frame. The daily records did not contain much detail and it was not possible to gain a complete picture of the person and their needs from reading the care plan.
Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 12 For another resident, with an indwelling catheter, important information had not been transferred from the old care plan file into the new one. As the old files have been stored away, there is a danger of this information being lost and of care needs being overlooked. Review records were not sufficiently detailed. Since the last inspection, medication storage has been improved. It is now in a different location, a new purpose made medication cupboard has been purchased, with appropriate storage for controlled drugs, plus there is a separate drugs trolley. A register is kept for the administration of controlled drugs. A new medication fridge has been obtained and temperature records are kept. A sample of medication administration records (MAR sheets) was checked against the corresponding blister packs. These had been signed for appropriately. However, on one MAR sheet, a medication change had been hand written, following a visit by a doctor. This was for a drug prescribed to be given twice a day that had been changed to incorporate a third dose, to be given in the evening, as required. The manager stated this had been a verbal instruction from the doctor, but there was no written confirmation. There was no written protocol for staff on the procedure to be followed on receipt of a verbal order, or the procedure for the administration of drugs prescribed to be given ‘as required’. The manager confirmed that regular audits of the MAR sheets are carried out. Staff were seen treating residents with kindness and respect, showing understanding and patience when interacting with residents who have problems with communication. Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 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 the following standard(s): 12, 14 & 15 Residents are given the opportunity to take part in a range of meaningful activities and are enabled to exercise choice in their daily lifestyles. Meals are provided in pleasant surroundings, they are well balanced, varied and offer choice to meet residents’ tastes and needs. EVIDENCE: An activities programme is displayed showing a range of varied activities during the week. On one afternoon of this inspection, an entertainer visited to provide musical entertainment, after which residents and visitors commented that they had enjoyed the social event. Residents are able to choose how and where they spend their time – a number of residents spend the mornings in their bedrooms and join other residents for lunch in the dining rooms, others prefer to have their meals in their rooms. A resident was enjoying listening to classical music in his bedroom. A small group of residents were clearly enjoying each other’s company in one of the smaller lounges, talking about current affairs and reading their newspapers. One resident had been out for a walk. Residents spoken to said that the food is good. Menus offer two choices of main meal with a starter consisting of soup on five days and prawn cocktail, melon, or Florida cocktail on Wednesdays and Sundays. Smoked salmon is on
Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 14 the menu once a month. The manager said this was asked for at a Residents’ Meeting. Residents are offered a glass of wine or ale before their Sunday dinner. The two separate dining areas are arranged with linen tablecloths, napkins and a large selection of condiments. The front dining areas have large picture windows that overlook the sea and provide a very pleasant setting. Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Residents know that their complaints will be listened to and acted upon. Good complaints records are kept. Policies and procedures are in place to safeguard residents from abuse. EVIDENCE: The home’s complaints procedure is prominently displayed with details of how to contact the commission. There is a complaints file by the visitors’ book with a selection of complaints forms that visitors may take away to complete if they wish. Residents spoken to said they had no complaints and the majority made positive comments about the home. Records of two complaints received since the last inspection showed that complaints are taken seriously and responded to. Since the last inspection, eight staff have attended training on abuse. Staff are currently working though a distance learning training pack on challenging behaviour. Written guidance on the management of aggressive behaviour is displayed in the office and detailed policies and guidance on abuse are included in the staff policies and procedures file, which is readily available. A staff member spoken to was confident about the procedure to be followed if abuse is suspected. The manager stated that abuse is discussed within the staff formal supervision sessions. Recent in-house training has also been provided, by one of the High Meadow organisation’s own trainers, on mental illness and dementia in the elderly. A copy of a certificate of attendance for this was seen on a staff file.
Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The decoration and furnishings of the environment provide residents with an attractive and homely place in which to live. The home’s maintenance procedures ensure residents’ safety. More attention is needed to ensure residents’ bedrooms are kept clean. EVIDENCE: Lounges and dining rooms are decorated and furnished to a good standard. Building maintenance is ongoing. The organisation’s maintenance manager was dealing with a problem with the home’s hot water system and had put contingency plans in place to ensure that there would be sufficient heating during the installation of a new hot water tank. All areas of the home were seen and the home is generally in good repair. The external fire escape stairs have been checked for safety following a requirement made at the last inspection. A structural engineer visited during the inspection and confirmed that it is safe to use in the short-term, as there are plans to install a new lift and connecting corridor at first floor level, when the external fire escape can then be removed. It is anticipated that work will start on this early in the New Year.
Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 17 The procedures in place for the control of infection include: the provision of appropriate hand washing facilities and plastic aprons and gloves readily available for use throughout the home. A staff member described the procedure for handling soiled articles, indicating that the correct procedure was being followed. The manager placed an order for some foot operated pedal bins, following discussion on the first day of inspection. Hazardous liquids are kept in lockable cupboards. There is a designated laundry assistant on duty weekday mornings, plus a part time housekeeper and one part time cleaner, but only one cleaner on duty on one day in the week and at weekends. The manager stated that residents’ bedrooms are cleaned once a week and in between the carers wash the ensuite toilets, washbasins and empty the bins. Bedroom cleaning is done in the afternoons, as a majority of residents choose to stay in their rooms in the mornings. A relative commented about this in their comments card. Some carpets had particles of dirt and crumbs on them and needed cleaning. Some older carpets in bedrooms are stained. The manager said these are being replaced as rooms are decorated. In view of the size and layout of the home, it is important that there is sufficient designated cleaning time that does not impinge upon the care hours provided. (See Staffing section, standard 27). Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The deployment and number of staff on duty do not properly take account of residents’ dependency needs, or the layout of the building. Procedures for the vetting of staff prior to employment need to be tightened to ensure that residents are fully protected. Recent training has developed staff skills and confidence. Staff demonstrated their understanding of good care practice principles. EVIDENCE: The staff rota indicated five staff on duty for care in the mornings and four in the afternoons and evenings. The manager stated that she has referred to the Department of Health Guidance on calculating staffing numbers. However, there are no dependency assessments in the residents’ care plans. The layout of the building is spread over three ground floor bedroom areas and two separate first floor areas, plus the main lounge area, and there was no evidence to verify whether this had been properly taken into account. As stated in the previous section on environment, care staff also have to undertake some cleaning tasks. Five relatives comments cards and two service users’ comment cards indicated that there are not always sufficient staff on duty, one commented, “staff are always busy and flitting about for residents.” The manager agreed to complete residents’ dependency assessments and to review the staffing levels to take account of these and the layout of the building. A copy of the staff-training matrix could not be printed off, but the manager said that the organisation is committed to staff training. The deputy manager
Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 19 has a National Vocational Qualification in care level 3, plus the Registered Managers Award. Various certificates were seen on staff files sampled of short courses attended. A staff member said there have been lots of opportunities to attend courses this year. Evidence was seen that the induction training complies with the Skills for Care specification. Four staff files were seen to contain application forms, job descriptions and statements of the terms and conditions of employment. Three files each contained only one reference and two had no evidence of identity checks. Evidence that Criminal Records Bureau checks (CRB) have been applied for is recorded on staff files, but the dates indicated in one file suggest that the person started work before the Protection of Vulnerable Adults register (POVA) first check and the return of the CRB disclosure. One file lacked any information to confirm whether a CRB and POVA check had been carried out. Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The manager provides clear leadership and has a good understanding of the areas that need to be improved in the home. The manager is supported by a strong senior management team. Systems are in place to ensure the home is run in the residents’ best interests with evidence that their views are sought. Safety procedures are generally satisfactory. EVIDENCE: Residents and staff spoken to were complimentary about the manager’s style and ready availability to them. Staff were appreciative that the manager ‘steps in’ to help with the care if needed. A staff member said, “the home has improved since the new manager took over.” An example was given that staff work more as a team under the manager’s leadership and that there is better use of manual handling equipment. A quality-monitoring file was seen to contain recently completed residents’ and staff questionnaires. Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 21 The manager confirmed that residents are encouraged to manage their own personal spending money if they are able, but in a majority of cases, relatives act on the residents’ behalf. There is an invoicing system for the payment of expenditures, such as: hairdressing and chiropody. The hairdresser records the amounts charged to each person. Some money was being held on behalf of one resident, but there were no records to indicate the date received, the amount, any expenditure and balance. The manager said she would start a record straight away. The manager stated that recent first aid training had been provided and that there is now a total of 14 staff with valid first aid certificates. Evidence was seen indicating that the home’s equipment is regularly maintained. The fire safety log book contained records of regular fire equipment tests and of staff fire instruction. Environmental risk assessments need reviewing and updating to take account of safety risks identified on the tour of the building, such as, the need to put a warning notice of a fire risk, by the oxygen cylinder kept in the lounge, prescribed for use by one particular resident. Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 2 x x N/A 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 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 2 x x 2 Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Pre-admission assessments must be sufficiently detailed and fully documented, showing how the person’s needs are to be met upon admission. This must be followed up with a full needs assessment following admission, from which the care plan is drawn up. The assessment of needs must be kept under review and revised when needs change. 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, covering all needs and risks identified. (Previous requirement timescale of 20/06/05 extended to 28/02/06) The registered persons must make proper provision for the health and welfare of residents. Health care needs must be followed up in the care plans and risk assessments.
DS0000034959.V257257.R01.S.doc Timescale for action 28/02/06 2 OP7 13, 14 & 15 28/02/06 3 OP8 12 & 13 28/02/06 Grenham Bay Court Version 5.0 Page 24 4 OP9 13(2) Dependency assessments to be completed and their results used to inform the care plans. Skin integrity and nutritional assessments must be undertaken, recorded and their results acted upon. There must be a written protocol 31/01/06 for the recording of verbal orders for changes to prescription only medications. Procedure to comply with the Royal Pharmaceutical Guidance 4.12 There must be a written protocol for the procedure to be followed by staff when a medication is prescribed to be administered as required. The frequency and timing of the cleaning of residents’ bedrooms to be reviewed and procedures put in place to ensure that bedroom carpets (or floorcovering) are kept clean. The numbers of staff on duty must be determined acccording to residents’ dependencies and the layout of the building. Evidence to be submitted by The registered persons must not employ staff unless they have assessed them as fit to work at the care home and information is obtained as specified in Schedule 2. Recruitment procedures must ensure that 2 references are obtained and CRB/POVA checks are carried out for all employees prior to their start date. A record must be kept of any monies received on behalf of a resident, to include, the date received, the amount, details of any expenditures, balance and written acknowledgement of the return of the money to the resident.
DS0000034959.V257257.R01.S.doc 5 OP26 23(2)(d) 31/01/06 6 OP27 18 31/03/06 7 OP29 19 28/02/06 8 OP35 17(2) Sch 4 20/12/05 Grenham Bay Court Version 5.0 Page 25 9 OP38 13 Environmental risk assessments must be regularly reviewed and updated to take account of any new safety risks. To include risks accociated with the use of oxygen cylinders. 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP30 Good Practice Recommendations To keep an up to date staff training matrix available for inspection. Grenham Bay Court DS0000034959.V257257.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Kent and Medway Area Office 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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