Inspection on 26/04/07 for Guysfield Residential Home

This inspection was carried out on 26th April 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Guysfield Residential Home 06/04/09

Guysfield Residential Home 07/04/08

Guysfield Residential Home 13/12/06

Guysfield Residential Home 26/10/05

Guysfield Residential Home 19/05/05

Guysfield Residential Home 07/10/04

Guysfield Residential Home 22/06/04

Guysfield Residential Home 17/12/03

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

CARE HOMES FOR OLDER PEOPLE Guysfield Residential Home Willian Road Willian Letchworth Hertfordshire SG6 2AB Lead Inspector Yoke-Lan Jackson Unannounced Inspection 26th April and 25 May 2007 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 Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Guysfield Residential Home Address Willian Road Willian Letchworth Hertfordshire SG6 2AB 01462 684441 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) guysfield@caringhomes.org www.concensusupport.com Caring Homes Healthcare Group Ltd Manager post vacant Care Home 51 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (51) of places Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13/12/06 (Key Inspection) 15th August 2002 (Pharmacy Inspection) Brief Description of the Service: Guysfield was originally a large Victorian house, subsequently sympathetically converted and extended to provide residential care for elderly people. It is situated in the quiet village of Willian, within a few minutes walk of the village amenities and about two miles from Letchworth town centre. The accommodation comprises forty-eight single bedrooms and one double bedroom, all with en-suite sink and toilet facilities, located on three floors. There are two passenger lifts, which serve all three floors. Three lounges, a large central conservatory and two dining rooms are on the ground floor as well as the main kitchen, the laundry facilities and the managers office. There is ample car parking space to the front of the property and a large garden to the sides. The home charges £450 to £650 per week. Further information can be obtained from the home’s Statement of Purpose and Service Users Guide. A copy of the latest CSCI inspection report should be available in the home. Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included a number of site visits with other agencies present. During these visits the provider’s representatives were also present together with the home manager. A joint inspection with Environmental Health Authority, took place on 26/04/07 and 02/05/07. A joint inspection with Hertfordshire Fire and Rescue Service took place on 02/05/07. In addition, a specialist Pharmacy Inspector checked the home’s medication procedures on 24/04/07. The inspection was completed on 29/05/07. The site visits included a tour of the premises and observation of the lunchtime routine. Residents, their relatives and staff were interviewed. Documents were examined. There were multi-agency discussions with the home manager and the provider’s representatives. (See below for details of the inspection findings) What the service does well: What has improved since the last inspection? Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 6 The home has complied with the statutory requirements made following the last inspection. A requirement was made to review medication storage facilities and this has also been done. Current arrangements are adequate. The pre-assessment document has been revised and the assessment procedure has been updated. All care plans have been revised and restructured. Risk assessments are carried out where there is potential risk to the health and safety of residents. All staff hours have been reduced to comply with European Working Directives. Training arrangements have been made to ensure that all staff have the appropriate training that is in line with Skills for Care guidelines. What they could do better: During the site visit on 26/04/07, it was noted that 4 wheelchairs that were broken had not been replaced. Following the site visit on 26/04/07, 4 new wheelchairs were purchased and delivered to the home the same week. A pharmacy inspection took placed on 24/04/07. As part of this inspection, a number of Statutory Requirements were made. Staff must follow the home’s policy and procedures for the safe use of medicines. The administration of medicines must be in accordance with prescribed instructions unless there are clear, recorded reasons why not. The records for the administration of medicines must be clear and accurate. During routine servicing of the water system in February 2007, the test for legionella bacteria was positive. Subsequent tests remained positive. On 26/04/07, a joint inspection was carried out with the Health and Safety Officer from the Environmental Health Authority. The home has engaged the services of a private firm to resolve this problem. Meanwhile the management has put in place measures to minimise the risk to residents, staff and visitors. A joint inspection was carried out with the Fire Officer from the Hertfordshire Fire and Rescue Service on 02/05/07. A number of recommendations were made. The management is complying with Statutory Requirements made by the Commission and work is in progress to comply with recommendations made by the other agencies. Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 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 Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective clients and their relatives have the information they need to make an informed choice of the home. They can visit the home and they can arrange a trial period of stay to ensure that the home is the right one for them. A prospective client is only admitted after a comprehensive assessment has been carried out to ensure that the home can meet their care needs. EVIDENCE: The care plans examined included the pre-admission assessment documents for each resident. The home will only admit those residents whose care needs can be met. Since the last inspection, the pre-assessment document has been revised and the assessment procedure has been updated. All senior staff have received training in how to fill in the new assessment form. Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are treated with respect, and their personal and health care needs are being met. However there are shortfalls in the administration of medication that need to be addressed. EVIDENCE: Since the last inspection the format for the written care plan is being revised to ensure that all aspects of the health, personal and social care needs of each resident are structured, detailed and clearly documented, including risk assessments where appropriate. The care plans examined showed that residents have access to their own doctor and to specialist medical, nursing and other therapeutic services when required. Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 11 The home will accommodate eight residents with mild forms of dementia but not residents who have challenging behaviour associated with dementia. Since the last inspection, more attention has been given to improving the facilities and meeting the social and recreational needs of those with dementia. Further training in dementia care is being arranged for all staff. Two senior carers (team leaders) have completed a one-day workshop in Dementia Awareness. A specialist Pharmacy Inspector checked the home’s medication procedures on 24/04/07. It was noted that the home has good written policies and procedures for the safe use and administration of medicines, but there is clear evidence that staff are not following these procedures and that they are not fully aware of what they contain. The level of training provided to some senior care staff to enable them to administer medicines safely and effectively is basic and must be improved. Assessments that people who administer medicines are competent to do so have not been carried out for all relevant staff. The defined procedure for obtaining medicines means that staff have sight of the original signed prescription from the GP. A copy should be retained in order to validate the prescribed instructions. A few residents self-medicate to a limited extent. Appropriate assessments were seen within the care plan files, although these were not up to date. Storage facilities provided for medicines were adequate and secure. The temperature of the storage rooms was adequate, but there was no monitoring or recording made of this, which is a requirement of the home’s own policy. The temperature of the fridge used to store medicines is recorded on a daily basis and is within acceptable limits. The cupboard in use for the storage of medicines controlled under the Misuse of Drugs Act 1971 conforms to the relevant regulations. Records of controlled drugs are completed appropriately. Stock levels of medicines were at a reasonable level, given the size of the home. Syringes of insulin are prepared by district nurses on a twice-weekly basis, and are left unlabelled for care staff to hand to the resident to selfadminister. This carries an unacceptable risk of medication error and must be reviewed. Records of medicines received and disposed of were adequate for most medicines but there was a tendency not to record the date of receipt of medicines when they had been received outside the normal ordering cycle. This means that their use is difficult to audit since a fully accountable audit trail is not possible. Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 12 Records of the prescribing and administration of medicines showed deficiencies, including, but not limited to: • An unacceptable number of gaps in the medication administration record charts (MAR) giving no indication of whether medicines have been administered or not. Nor was there any reason recorded for their omission. • Medication not administered to residents in accordance with the prescribed instructions. • Changes or additions to instructions for prescribed medication but no indication in the MAR charts of who made each change, when it was made or any justifiable reason for it. • Hand-written medication record charts did not always clearly record the date on which medication had been administered to residents. Records of the results of doctor’s (GP) and other professional visits were limited and did not give a clear indication of the results of such consultations. Care plans did not carry clear guidance for the use of medicines prescribed on a ‘when required’ basis. The management is complying with the requirements made by the specialist Pharmacy Inspector. Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are offered choices in their daily routine, and their preferences are respected. They have close links with their relatives and friends. The meals provided are nutritious and wholesome. However, the daily recreational and therapeutic needs of some residents are not always met because there is not enough staff to assist with activities. EVIDENCE: On the day of the inspection, it was noted that carers were supporting those residents who needed assistance at mealtimes. The carers were patient and gentle in their approach and mealtime was unhurried. A relative, who was present in the dining room at the time, said, “I am quite happy. The carers are kind to my dad.” Visitors are welcome at any reasonable time and may be entertained in any of the communal areas or in residents’ bedrooms, according to individual preference. The management is reviewing the activity programme to ensure that the recreational activities provided are stimulating and therapeutic, especially for Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 14 those residents with dementia. There is an activity record for each resident. Current activities include bingo, puzzles, video films/cinema sessions, nail care, hairdressing, old time music hall, piano/organ recitals, and visits to the library and local walks. There is a regular communion service for those who wish to take part. There is an activity co-ordinator who is working towards an Activities Training Assessment certificate. However, one activity co-ordinator is not sufficient for the current group of residents. Some residents require one-to-one assistance. Feedback from carers indicated that they do assist with activities if they have the time, but very often they are not able to because they are too busy with personal care. Several residents were observed sitting in the conservatory and communal lounge with little one-to-one interaction. Carers were busy attending to individuals who required personal care. One resident said, “I would like to go for a walk sometimes, but the carers are too busy to take me. I am afraid to ask them”. Another resident, who has restricted mobility, would prefer to be outside in the garden, but he would require a wheelchair and someone to assist him. He said, “It would be nice to be outside but I need someone to help me”. He added, “The carers are very busy so I didn’t want to ask them.” Since the inspection, the management has increased the staffing level by one per shift to assist with activities. Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust Complaints Policy and Procedure and residents’ legal rights are protected. EVIDENCE: The home has a satisfactory complaints procedure in place. Residents and their relatives are encouraged to make their concerns and complaints known. Residents spoken to said that they know how to make a complaint, and they know who to speak to if they are unhappy. Complaints records show that matters raised are dealt with speedily and satisfactorily. Training in the protection of vulnerable adults has been provided for all the staff, and the staff spoken to were aware of their responsibilities for whistleblowing. The home follows the Adult Protection Procedure of Hertfordshire Social Services. Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 25, 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents and staff are currently exposed to some health and fire hazards. Management is addressing these, and work is in progress to improve the environment. EVIDENCE: During the annual test for legionnaires disease in the water system in February 2007, the test result for legionella bacteria was positive. Subsequent tests remained positive. A joint inspection was therefore carried out the Health and Safety Officer from Environmental Health Authority on 26/04/07. Since then the management has been in direct contact with Environmental Health. The home has engaged the services of a private firm to resolve this problem. Meanwhile the management have put in place measures to prevent the risk to Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 17 residents, staff and visitors. Further work includes fitting to each of the hot water boilers and main inlet valves a number of copper silver ionisation units, to eliminate any further traces of legionella bacteria at source. This work will commence on 31/05/07. A joint inspection was carried out with the Hertfordshire Fire and Rescue Service in view of fire hazards discovered during the site visit on 24/04/07. The Fire Officer had made several recommendations, which will be issued in his own report. During the site visit on 26/04/07, it was noted that 4 wheelchairs were broken and had not been repaired for some months. Although a requisition had been to head office, the provider had not responded. Following the site visit, 4 new wheelchairs were purchased and delivered to the home the same week. Work is in progress to comply with recommendations from Hertfordshire Fire Authority and Environmental Health, Hertfordshire County Council. Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported and protected by the home’s recruitment policy and practices. There is a team of dedicated staff. However, it would benefit the residents more if the staffing level were increased so that the positive care provided would be consistently maintained to a high level. EVIDENCE: The home has a team of dedicated workers, whose skills and experience are not utilised to their full potential. One carer spoken to has computer skills and she expressed an interest in helping the activity co-ordinator to research into activities to help improve the activity programme. The management is setting up a rolling programme of training for every member of staff in specific topics that are relevant to meeting the needs of the current group of residents. Further training topics include, ‘Care Plans and Report Writing’, ‘Activities’, ‘Prevention and Care of Pressure Areas’ and ‘Care of Pressure Sores’. Arrangements are being made with the local social services for further training in dementia care. Since the last inspection, the home is following the Skills for Care Guidelines for the Induction Training programme. Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 19 On the day of the inspection, the staffing level consisted of one team leader and six carers for the morning shift. Since the inspection, the number of carers has been increased to one team leader and seven carers for the morning shift, and one team leader and six carers for the afternoon shift. It is recommended that the management review the general staffing level for both day and night shifts to ensure that the current minimal staffing level is not a contributory factor towards the high incidence of falls among the current group of residents. The management staff have recently attended a seminar on falls. It is recommended that all staff have training on the prevention of falls. The home has robust policy and procedures for recruitment. Proper checks are made, including Criminal Record Bureau (CRB) checks and the protection of Vulnerable Adult (POVA) checks, before new recruits commence work. (See Statutory Recommendations) Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of administration and management of the home is improving. The home has sound policies and procedures to safeguard the health, safety and welfare of residents. However, not all members of staff adhere to the Medication Policy and Procedures. EVIDENCE: The home manager has submitted her application to be considered for registration with the Commission, CSCI. She has completed the Registered Managers Award and is working towards NVQ level 4 in Care. Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 21 During the site visits, the Area Manager and the Facilities Manager were present to support the home manager. The home has two team leaders who have management responsibilities. Following discussion, the home manager will ensure that the team leader who is managing a shift in the manager’s absence will be supported by an additional senior carer to help with the practical care needs of residents. The home manager has agreed that the additional bedroom will not be occupied until the windows have been replaced and the room has been made safe and fit for its occupant. The home is not involved with the residents’ finances but the management oversee the personal allowances for each resident and proper accounting records are kept. All servicing records are well maintained except for previous certificates connected with the test for legionnaires in the home. The management is advised to keep copies of all servicing records if the originals are kept at head office. A specialist firm is being employed to help resolve the presence of legionella bacteria in the water system. The Environmental Health Officer is overseeing the current situation. The management is complying with the recommendations of Hertfordshire Fire and Rescue Service, and work is in progress to ensure the safety of all residents and staff. The provider carries out regular audits of the home, with resulting action plans. A quality assurance and monitoring system that includes survey questionnaires for residents, relatives, staff and others is being developed. Information received will be collated and analysed by an external body. It is recommended that staff are given regular in-house discussion sessions on specific policies and procedures, in particular, the Medication Policy and Procedures, to ensure that these are being followed consistently. Further accredited training on medication is being arranged for members of staff. (See Statutory Requirements and Recommendations). Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 X 2 X X 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 3 2 2 Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 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 OP9 Regulation 13(2) Requirement Residents must be given medication in accordance with the prescribed instructions. Medication prescribed for residents must be recorded and administered safely and appropriately. This is a repeat requirement, previous timescale of 14/03/07 not met. Clear and accurate records must be kept of the date on which medication is administered to residents. Staff authorised to administer medicines must be trained and assessed as competent to do so. All parts of the home should be free of hazards to safety, including fire hazards and the risks connected with legionella bacteria in the water system. (Work is in progress) Timescale for action 15/05/07 2. OP9 13(2) 15/05/07 3. OP9 17(1) 15/05/07 4. OP9 13(6) 01/06/07 5. OP19OP25 OP38 13 (4) (a) & (c) 23 (4) 31/08/07 Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 24 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 OP27 Good Practice Recommendations It is recommended that the management review the general staffing structure and numbers for both day and night shifts to ensure that at all times suitably qualified and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of residents. It is recommended that all staff have training on the prevention of falls. It is recommended that staff are given regular in-house workshop and discussion sessions on specific policies and procedures, in particular, Medication Policy and Procedures, to ensure that these are being followed consistently. 2. 3. OP30 OP38 Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Guysfield Residential Home DS0000019399.V337715.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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