Inspection on 14/11/05 for Harefield Nursing Centre

This inspection was carried out on 14th November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Harefield Nursing Centre 25/06/07

Harefield Nursing Centre 11/09/06

Harefield Nursing Centre 08/05/06

Harefield Nursing Centre 25/04/05

Harefield Nursing Centre 05/10/04

Harefield Nursing Centre 15/04/04

Harefield Nursing Centre 10/09/03

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

CARE HOMES FOR OLDER PEOPLE Harefield Nursing Centre Hill End Road Harefield Middlesex UB9 6UX Lead Inspector Mrs Rekha Bhardwa Unannounced Inspection 14th November 2005 10:25 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 Harefield Nursing Centre DS0000010932.V262969.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. Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Harefield Nursing Centre Address Hill End Road Harefield Middlesex UB9 6UX 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) 01895 825 750 01895 825 760 ANS Homes Limited Miss Eileen Louise Ward Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 40 ELDERLY FRAIL NURSING MINIMUM STAFFING NOTICE One service user, date of birth 16th August 1945 can be accommodated at the home, as agreed on 2nd April 2004. 7th September 2005 Date of last inspection Brief Description of the Service: The Harefield Nursing Centre is a purpose built home to accommodate 40 service users. It is situated in a semi-rural setting close to Harefield Hospital and Harefield Village and is served by public transport. The home was built in 1995 and all bedrooms are single occupancy with en suite facilities. The home consists of two floors with a lift. The first floor houses the kitchen, laundry and staff facilities and the ground floor is the living area for the service users. There are two spacious communal lounges and a dining room. The gardens are well maintained. Public transport in the form of Bus services are available in Harefield village and there are shops available in the village also. Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 14 hours was spent on the inspection process. The Inspector carried out a tour of the home, and inspected service user plans, medication records, financial records, servicing, maintenance and fire safety records. 10 service users, 2 visitors, 4 staff and 2 visiting healthcare professionals were spoken with as part of the inspection process. The purpose of this inspection was to follow up the requirements and recommendations from the last inspection, and to view some additional standards. The majority of key standards were viewed at the last inspection and it is recommended that this report be read in conjunction with the last report to gain full inspection information for the home. Four additional visits have been carried out to the home since the last inspection, in relation to concerns regarding wound management. What the service does well: What has improved since the last inspection? What they could do better: The issue with service users with dementia is still to be fully addressed, as the home is not currently registered to accommodate service users with dementia. Whilst it is acknowledged that, in the main, medications are being managed, shortfalls were noted, to include issues with the administration instructions and Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 6 waste disposal of medications. Requirements in relation to environmental and staffing audits had not been addressed. Shortfalls in the staff records, servicing records and aspects of fire safety were noted. 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. Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 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 the following standard(s): 2 and 4 Written agreements are in place and provide service users with clear information about the terms and conditions of the home. Where the service user is not within the category of registration they must not be admitted to the home, as the home would not be able to meet their specialist needs. EVIDENCE: Contracts and placement agreements were available for all service users. Where service users are funded by the Local Authority the main contract is held with the Registered Provider. Since the announced inspection in April 2005 the home has not yet applied for a variation to their registration in relation to the accommodation of service users with dementia. The CSCI is aware that work to progress this has been carried out and is ongoing. One service user with a differing specialist care need had been accommodated at the home. There was evidence that the home had accessed specialist nursing and medical input to meet the service users needs. A variation to the conditions of registration needs to be applied for in respect of this service user. Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9 and 11 Improvements were noted in the completion and content of the service users plan, with some shortfalls requiring addressing to ensure that the service users current needs are fully identified and met. Generally medications were being managed, however shortfalls identified could potentially place service users at risk. Service users changing needs are identified and met, thus ensuring appropriate care is provided. EVIDENCE: A sample of service user plans were viewed. Overall these were up to date and had been reviewed monthly and whenever a service users condition changed. There was evidence of care plans being formulated for newly identified problems. For one service user with specialist care needs requiring medical treatment, the service user plan did not reflect the treatment being received. There was not evidence in all the service user plans viewed that the service user and/or their representatives had been involved in the formulation and review of the service user plans. Wound care documentation viewed was comprehensive, detailed the dressings to be used, details of the progress of the wound and photographs. The Inspectors spoke with the Tissue Viability Nurse from Hillingdon Primary Care Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 10 Trust who confirmed that significant progress had been made with the existing wounds within the home. At the time of the inspection there were seven pressure sores. Pressure relieving equipment was seen in use throughout the home and had also been identified in the service user plan or the pressure sore risk assessment. Moving and handling, Pressure Sore risk assessments, risk of falling, nutritional and continence assessments were available in service users files viewed. Bed rail and lap strap assessments were in place and had been agreed with the service users representative. One Inspector noted that one service user required twice daily blood sugar readings. The blood glucose chart indicated that on several days blood sugar readings were only taken daily and in one instance not at all. For one service user whose care plan stated that they were to be weighed weekly, monthly weight recordings were seen. These shortfalls were discussed with the Registered Manager at the time of the inspection. The Pharmacy Inspector carried out a full inspection on 21/07/05 and a separate report from that inspection had been forwarded to the home. On this occasion one Inspector sampled records and the management of medications. Samples of medication administration records were viewed. Medications had been signed for at the time of administration. Allergies are now being recorded on the Medication Administration Record(MAR) chart and where no allergy is known this is also recorded. The Inspector noted that for one service user Lorazepam had been prescribed. The instructions stated that half a tablet was to be given in the morning and one tablet at night. No strength was stated and both were written in one instruction box. It was discussed with the Registered Manager that there needed to be two separate entries both clearly recording the strength of the tablet. Liquid medications had the date of opening recorded and generally receipts of medication were well recorded. Variable doses of medication, for example, paracetamol were not always recorded and this was a repeat finding. The registered nurse said that the service users concerned always have 2 tablets, so the Inspector recommended that this be discussed with the GP, so that the administration instructions can be amended accordingly. One service user had been prescribed Warfarin and the instructions stated that this was to be administered ‘as prescribed by the anticoagulant clinic’. The need to keep the blood results with the MAR chart for reference and accuracy was discussed with the Registered Manager. This is a repeat finding. Medication fridge temperatures and room temperatures were being recorded. There appeared to be a problem with the thermometer for the fridge as the recording at the time of the inspection was –11ºc, and previous recordings indicated mainly minus readings for minimum and actual fridge temperatures. Room temperatures were being recorded daily, and, with a few exceptions during periods of hot weather, these were maintained at 25º centigrade or below. The staff were using single use disposable lancets for blood glucose monitoring. Other devices and needles for blood glucose monitoring were Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 11 available but the registered nurse spoken with said that these were not in use. The Inspector recommended disposal of any devices for individual service user use. The Controlled Drugs register was viewed and all balances viewed were correct and satisfactorily recorded. Several prescription only creams and ointments were being stored in the en suite facilities, and the Registered Manager said she would arrange for these to be removed to safe storage in the clinic room. This is a repeat finding. The storage of waste medication in the home was poor and a potential hazard. The first floor store cupboard contained several containers of medication that needed to be collected by the contracted waste disposal company. Sip feeds and Calogen were being stored in this room also. It was not clear that the policy and procedure for medication had been updated to reflect the changes in the disposal of waste medication. The need for two registered nurses to record and witness all medications for disposal was discussed. The floor was found to be sticky due to a spillage of lactulose. All these areas were discussed with the Registered Manager and a date of 25th November 2005 agreed to have the waste medication removed. The service users plans are updated whenever there is a change in the service users condition and the home aims to ensure that the wishes of the service users and their representatives concerning their care in their final days are recorded and respected. Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 – 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Dietary needs of service users are well catered for with food choices provided and food available that meets service users preferences. EVIDENCE: The menu has been revised since the last inspection. Choices are now being provided at each meal and service users comments confirmed this. The lunch mealtime was viewed by one Inspector. The home has two sittings, the first sitting being for service users who require assistance with their meal. This was being undertaken sensitively and appropriately and the cook was present during the meal to assist and receive feedback from service users. Juices were available and hot and cold drinks are offered throughout the day, with water jugs being provided in the service users bedrooms. The Inspector sampled a main meal option plus an alternative meal provision. The food sampled was well presented and cooked, and was tasty. Service users spoken with expressed their satisfaction with the meal provision, and it was clear that additional choices are provided where requested. Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 The home has a clear complaints procedure in place to address any concerns raised by service users and their visitors. Systems are in place for the protection of vulnerable adults so as to protect them from possible risk of harm or abuse. EVIDENCE: Since the last inspection in April 2005, the home had received 15 complaints. There was evidence of responses to the complainants and any outcomes were recorded. It was recommended that the Registered Manager keep a complaints summary of all complaints and their progress status. All staff have received training in the protection of vulnerable adults (POVA). Since the last inspection there had been one POVA investigation which has been resolved. Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 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 the following standard(s): 19, 21 and 26 The home is generally clean and tidy and the environment is safe for service users to use. A review of the premises with regard to heating, storage, bed provision and fittings and furnishings is required to ensure that the premises are warm and furbished appropriately that service users assessed needs are met. Shortfalls identified in relation to infection control could potentially place service users at risk. EVIDENCE: A tour of the premises was undertaken by both Inspector. There was evidence of extensive redecoration within the home and a programme for redecoration is in place. The grounds were well maintained and there was evidence of ongoing seasonal planting. It was noted that there are no radiators situated in the en suite facilities, and in some instances these rooms were chilly. Some bedrooms did not have a lockable facility. The home only has 12 adjustable beds and the majority of the service users accommodated at the home have moving and handling needs. An environmental audit of the premises must be carried out (this is a repeat requirement) and an action plan drawn up for the refurbishment of the building to include the shortfalls identified above. Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 15 Bathrooms, toilets and the sluice rooms were viewed. The sluice room on the red side was cluttered and odorous. A box containing communal underwear was seen and removed at the time of inspection. Several irons, ironing board, and prescribed creams were also seen in this room. The Registered Manager said that she would arrange for these to be removed and stored appropriately. Bathrooms viewed were generally clean but some were being used as storage space. The Registered Manager stated that one bathroom with a ‘Parker bath’ is not used. The shower room on the blue side had been refurbished and made into a ‘wet room’ shower facility. Protective clothing to include gloves and aprons were available. The training summary indicated that staff had received infection control training. Liquid soap and paper towels were available in areas where staff, service users and visitors may require to wash their hands. Bars of soap had been left in two of the bathrooms. In one en suite, the night bag for the service users continence management was hanging over the toilet and the cover had not been replaced on the connection point, which is a potential cross infection risk. Localised malodours were noted. The overall odour control in the home had improved and it is acknowledged that staff work hard to manage the odours. Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 16 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 and 29 The staffing provision was appropriate to the meet the needs of the service users, thus providing them with appropriate care. The systems for the recruitment of staff need improving to safeguard service users. The home is aware of the need for ongoing induction, foundation and NVQ training for staff to provide them with the skills to address the needs of service users. EVIDENCE: On the day of inspection the staffing levels were appropriate to meet the needs of the service users. In October 2005 the CSCI had requested a formal review of the staffing provision, which does not appear to have been carried out to date. It is acknowledged that there were 32 service users accommodated at the time of inspection. The rosters indicate that there are sufficient ancillary staff employed over the seven day period. The staffing will be viewed again in detail at the next inspection. The NVQ and induction and foundation training will be reviewed after the end of November 2005, when BUPA training schemes will be introduced. This standard will be viewed in depth at the next inspection. A sample of staff files were viewed by one Inspector. One file only contained one reference and in another file a full employment history was not available, and one reference, received via email, did not tally with the employment information supplied. The application forms do not ask for explanations for any gaps in employment. The BUPA application forms will be being used from the end of November 2005, which are more comprehensive. BUPA human Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 17 resources had carried out an audit of the staff files, and shortfalls had been identified. The need to address these shortfalls was discussed with the Registered Manager. Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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, 35, 37 and 38 The Registered Manager is experienced to manage the home. The completion of a management qualification would update and enhance her management skills and thus facilitate current management practice in the home. Service users monies are well managed and secure procedures are in place. Overall the home is well maintained, but shortfalls in some areas of maintenance and health & safety could potentially place service users at risk. EVIDENCE: The Registered Manager has recently become registered by the CSCI. She stated that she would be commencing the Registered Managers Award in the near future. One Inspector viewed some of the records for service users personal monies. These were up to date and the income and expenditure was clearly recorded and receipts were available. Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 19 The service user plans are held in lockable filing trolleys. Overall they are maintained and kept up to date (see standards 7 & 8). Servicing records were viewed at random and it was noted that the fire alarm panel had not been serviced since August 2004. The Registered Manager said that she would request for this to be carried out within the next 4 days. The fire risk assessment had not been reviewed, even though there had been a fire in the laundry room in May 2005. There was no evidence that night staff fire drills had been carried out in the last year and only one day time fire drill had been undertaken. This is a repeat finding. The maintenance man carries hot water temperature checks on the hot water outlets throughout the building out monthly. The training summary indicated that moving & handling, fire safety and food hygiene training had been undertaken. Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 20 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 X 3 X 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X 3 2 Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 21 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 OP4 Regulation 12(1)(b) 14(1)(d) Requirement Where a service user is incorrectly placed, a variation of registration must be applied with evidence of how the home will meet the needs of that service user. (timescale 04/07/05 not met) Service user plans must clearly reflect any treatment being provided to the individual. There must be evidence that the service user plan has been formulated and reviewed with the service user and/or their representative. The frequency of any observations being carried out must tally with that identified in the service user plan. The strength of all medications must be recorded on the MAR chart. Where varying doses are prescribed, separate entries on the MAR chart must be made to clearly identify each strength to be administered. The fridge must be defrosted and the temperature maintained between 2 and 8 degrees DS0000010932.V262969.R01.S.doc Timescale for action 01/01/06 2 3 OP7 OP7 17(1)(a) 15 01/12/05 01/01/06 4 OP8 17(1)(a) 01/12/05 5 OP9 13(2) 25/11/05 6 OP9 13(2) 25/11/05 Harefield Nursing Centre Version 5.0 Page 22 7 OP9 13(2) 8 OP9 13(2) 9 OP9 13(2) 10 OP9 13(2) 11 OP9 13(2) 12 13 OP9 OP19 13(2) 12 14 15 OP21 OP26 23(2) 16(2)k 16 OP26 13(3) centigrade. (previous timescale 01/08/05 not met) Where a variable dose of a medication is prescribed, the actual dose administered must always be clearly recorded. Administration instructions must be clearly recorded. It is good practice to keep a copy of the most recent warfarin dose instructions with the MAR to avoid error. Prescription creams and ointments must be stored securely in the clinic room when not in use. Waste medicines must not be allowed to accumulate. They must be recorded accurately and stored securely in appropriate containers. Arrangements for regular collection must be in place and the current waste stock collected for disposal. The medication procedures must be updated to include the new requirements for the disposal of waste medications. All areas used for medication storage must be maintained in a clean condition. A full environmental assessment must be undertaken and a copy of the assessment report and planned action sent to the CSCI. (timescale 04/07/05 not met). This must include the action to be taken to address shortfalls in adjustable bed provision, en suite heating and fixtures and furnishings. Bathrooms must not be used as general storage areas. Where malodours are present, this must be assessed and appropriate action taken to address the reasons identified. Toiletries must not be left in DS0000010932.V262969.R01.S.doc 25/11/05 21/11/05 21/11/05 25/11/05 01/12/05 25/11/05 01/01/06 01/12/05 01/12/05 01/12/05 Page 23 Harefield Nursing Centre Version 5.0 17 OP26 13(3) 18 OP27 18 19 20 OP29 OP38 7,9,19 23(4) 21 OP38 23(4) 22 OP38 23(4) communal areas. Suitable infection control procedures must be in place for the safe storage of continence care products. The Registered Manager must undertake a review of the staffing provision. This review must include dependency levels, individual needs of service users, the number of staff and their deployment, skills and abilities. A copy must be forwarded to the CSCI. Staff records must contain the information required under the Care Homes Regulations 2001. The fire risk assessment must be reviewed annually and whenever there is a relevant change or event in the home. All fire safety equipment to include the fire alarm panel must be serviced at the required intervals. All staff must receive regular fire drill training, including night staff. (timescale 01/06/05 not met) 01/12/05 01/01/06 01/12/05 01/12/05 21/11/05 01/12/05 Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 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 OP9 Good Practice Recommendations Where service users are not requiring a variable dose of a medication, this should be discussed with the GP and where appropriate the administration instructions amended accordingly. It is strongly recommended that the finger pricking devices not suitable for multi-patient use that are currently being stored should be disposed of. 2 OP9 Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST 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 Harefield Nursing Centre DS0000010932.V262969.R01.S.doc Version 5.0 Page 26 - 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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