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Inspection on 09/05/05 for Harry Lord House

Also see our care home review for Harry Lord House for more information

This inspection was carried out on 9th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The New Manager had identified the courses that staff required to enhance and develop their skills. All staff members had a training and development plan containing their training and development needs. The plans had been devised following discussion between the staff members and the manager. The Manager had collated the information and recorded it on a single chart to help her plan and monitor the staff team`s training. This is good for the staff and residents.

What has improved since the last inspection?

Since the last inspection, staff had been measuring the hot water temperatures daily to protect residents from scalds. The staff were checking that first aid kits were full. Broken door guards, to stop residents trapping their fingers, had also been repaired. The records of residents` monies, held for safekeeping by the home, had improved since the last inspection. Care plans and day-to-day records about residents had also improved since the last inspection.

What the care home could do better:

Not enough information was provided to allow residents and their families to make choices. Residents` needs were assessed before they were admitted tothe home, but these were not always recorded in the daily records. This could limit the effectiveness of the measures taken to meet the residents` needs as they may wish them to be met. Staff needed more practice and training at writing care plans for residents. While records had improved since the last inspection, the records could be further improved and requirements were made about this. The administration and recording practices regarding medication were unacceptable and potentially dangerous. The home must take urgent action to address the issues raised at the time of the inspection. The home must fully assess and record the residents` nutritional needs in their care plans. Some parts of the premises needed redecorating and replacement carpets to make the home more pleasant for the residents living there. The home`s staff were working hard to look after the residents, but the home did not have sufficient staff to meet the needs of the residents. One staff member clearly stated her view that the staff did not have enough time to watch over frail residents and to spend time simply listening to residents and talking with them. The home needed to take urgent action to improve the poor fire safety control and procedures, so that residents and staff were not put at risk. Staff needed training in how to deal with complaints and how to protect resident from abuse.

CARE HOMES FOR OLDER PEOPLE Harry Lord House 120 Humphrey Road Old Trafford Manchester M16 9DF Lead Inspector Helen Dempster Unannounced 9 May 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Harry Lord House Address 120 Humphrey Road Old Trafford Manchester M16 9DF 0161 872 4156 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Trafford Metropolitan Borough Council Responsible Individual - Anne Elizabeth Higgins PC Care home only 45 Category(ies) of DE(E) Dementia - over 65 registration, with number OP Old Age of places Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The home provides accommodation for a maximum of 45 service users, 29 of whom require care by reason of old age (OP) and 16 of whom are older people who require care by reason of dementia (DE(E)). Separate lounge and dining space must be provided to meet the needs of the service users who require care by reason of dementia (DE(E)). There are currently 8 named older service users who require care primarily by reason of mental ill health (MD(E)) and 1 named older service user who requires care primarily by reason of physical disability (PD(E)). Should any of these service users no longer require accommodation at the home, 7 of the places will revert to the category (DE(E)) and 2 of the places will revert to the category (OP). The Statement of Purpose must be maintained in line with the requirements of Schedule 1, of Regulation 4(1) of the Care Homes Regulations. The Statement must be kept under review and updated. Any changes to the homes purpose must be agreed with the Commission for Social Care Inspection prior to implementation. The staffing arrangements at the home must be maintained in line with the minimum levels set out in the guidance published by the Residential Forum, `Care Staffing in Care Homes for Older People`. This must be reflected in the Statement of Purpose. The home must be managed at all times in accordance with the guidance and regulations issued in respect of older peoples` homes by the Secretary of State for Health under Sections 22 and 23(1) of the Care Standards Act 2000. The authority must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 23 November 2004 Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 5 Brief Description of the Service: Harry Lord House is a purpose built Registered Care Home, which is owned and managed by Trafford Metropolitan Borough Council. Accommodation is on 3 floors. Access to the first and second floors is by staircase, or vertical passenger lift. There are 7 lounges and a wide variety of bathing facilities, including a walk-in shower and Parker bath. There are 33 single and 6 double bedrooms. The home is situated in a quiet residential area and is close to the Metro link. Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was conducted by 2 inspectors. It started at 11am and finished at 8pm on 9th May 2005. It was of concern that just 8 of the 16 requirements made at the previous inspection in November 2004 had been addressed. There were also issues about medication, staffing and fire safety, which the organisation needed to address immediately to ensure the residents’ safety. Immediate requirements were made regarding the identified issues at the time of the inspection and follow up visits will be made to the home to monitor the progress being made. The inspectors spoke to 21 of the 36 residents, one resident’s relative and a range of staff, including the new manager. What the service does well: What has improved since the last inspection? What they could do better: Not enough information was provided to allow residents and their families to make choices. Residents’ needs were assessed before they were admitted to Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 7 the home, but these were not always recorded in the daily records. This could limit the effectiveness of the measures taken to meet the residents’ needs as they may wish them to be met. Staff needed more practice and training at writing care plans for residents. While records had improved since the last inspection, the records could be further improved and requirements were made about this. The administration and recording practices regarding medication were unacceptable and potentially dangerous. The home must take urgent action to address the issues raised at the time of the inspection. The home must fully assess and record the residents’ nutritional needs in their care plans. Some parts of the premises needed redecorating and replacement carpets to make the home more pleasant for the residents living there. The home’s staff were working hard to look after the residents, but the home did not have sufficient staff to meet the needs of the residents. One staff member clearly stated her view that the staff did not have enough time to watch over frail residents and to spend time simply listening to residents and talking with them. The home needed to take urgent action to improve the poor fire safety control and procedures, so that residents and staff were not put at risk. Staff needed training in how to deal with complaints and how to protect resident from abuse. 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. Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 Insufficient information was provided to allow residents and their advocates to make choices. Residents’ needs were assessed before they were admitted to the home but these weren’t monitored in daily records so that their needs could be consistently met. EVIDENCE: The Statement of Purpose and Service Users Guide were not readily available at the time of inspection. When found, they required updating and the requirement made at the last inspection was reiterated. Residents were having their needs assessed before moving into the home. Examples of the ‘Statement of Needs and care plan’ and the Multi-Disciplinary Assessment (MDA) were seen and found to contain a range of information. Daily reports at the home did not make reference to needs identified in the needs’ assessment and care plan. A requirement was made accordingly. Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 9 Overall, care plans were informing staff how residents wanted to be cared for, but staff needed more practice at writing about outcomes for residents. Medication storage, administration and recording was putting residents at risk. EVIDENCE: Care plans had improved since the previous inspection. However, a care plan was not in place for a resident admitted on 16/02/05 and some care plans included statements like ‘diagnosed with dementia’, without recording details of the outcome for the resident, the behaviour of the resident and how their needs would be supported. A requirement was made accordingly. Two requirements made at the previous inspection concerning medication practice had not been actioned and the timescales had lapsed on 31 December 2004 and 31 January 2005. These issues and a number of further concerns about medication practice, which could put service users at risk, were discussed during the inspection. These were as follows: Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 11 1. 2. 3. 4. 5. 6. There was no policy for recording the receipt of respite care medication and the receipt of medication for one service user, admitted for respite care on 30 April 2005, had not been signed for. This was the subject of a requirement at the previous inspection, the timescale of which lapsed on 31 January 2005. Correction fluid i.e., obscuring liquid paper was being used on the MAR sheets to obliterate information. The recording on MAR sheets did not provide a full audit trail. In particular, there were gaps in the record so that it was unclear whether medication had been administered or not. Staff had been signing for administration of medication for one resident at a time when it was not supplied or prescribed. Medication details were handwritten onto MAR sheets with no administration details e.g., eye drops for which neither the time of day or dosage was noted on the MAR. One service user was self-administering his insulin injection. There was no risk assessment on this individual’s file concerning this. Some issues concerning the storage of medication were of concern. Insulin (Humalin) was being stored in a fridge, but was being drawn up in advance for a 7 day period for one service user and kept in a medication cupboard in the general office which was reported to get excessively hot. The patient advice leaflet stated that the insulin must be kept between 2°C and 8°C. Phenobarbitone was being administered from bubble packs for one service user. The home obtained the advice of the pharmacist on the storage of both these items at the time of inspection. Immediate requirements were made about all these issues and the home was advised, in writing, that they must be addressed by 12 May 2005. Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 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 standard(s) 12 and 15 Some group social activities were provided. However, residents’ social needs were not being met on an individual basis by the home. Residents were provided with a varied diet, however nutritional needs were not being fully assessed. EVIDENCE: There was an entertainer in one of the lounges, which residents seemed to enjoy. However, at the time of inspection, staffing levels were very low and staff were saying that they were unable to find time even to talk to residents (See staffing section for details). When activities did take place, who participated and the outcomes for the residents were not consistently recorded. Menus were in place which gave residents choices, but their nutritional needs were not fully documented and monitored in a detailed care plan. The requirement made at the previous inspection was reiterated. Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Lack of staff training and familiarity with how to implement the home’ s complaints procedure and Protection of Adults from Abuse Policy was restricting residents concerns being heard and could, potentially, put residents at risk. EVIDENCE: At the time of inspection, the senior member of staff couldn’t find the complaints record. This record was produced by the manager on the afternoon of the inspection. It was found to need updating. The senior member of staff on duty on the morning of the inspection said that a resident’s relative had made a complaint on the previous day. The details of this complaint had not been entered on the complaints record. The home did have a copy of Trafford Metropolitan Borough’ s ‘Protection of Adults from Abuse Policy’. Staff, including a senior member of staff, were not familiar with it’s content. Staff had not received training in the implementation of this policy. The Manager stated that this training was scheduled to be provided. Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 25 The premises lacked robust fire safety precautions, which could put residents and staff at risk. Precautions were being taken to protect residents from scalds. Some parts of the premises needed refurbishment to make them more attractive for residents. EVIDENCE: The premises did not meet fire safety standards, work to bring the premiises up to standard had not commenced at the time of inspection, and fire safety procedures were inadequate. (See the Management and Administation section of the report for details) In response to a requirement made at the previous inspection, the home was consistently monitoring hot water temperatures to ensure that they were safe. All radiators and pipework were covered. Broken door guards, to limit the risk Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 15 of residents trapping their fingers, had also been repaired. Since the last inspection, staff were checking that first aid kits were fully stocked. Some parts of the home were in need of refurbishment. This included the need to redecorate some parts of the ground floor area and replace some carpets in this area. A requirement was made to the effect that the home conducts an audit of necessary work. Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Inadequate staffing levels were putting residents at risk. EVIDENCE: A tour of the building was conducted to assess deployment of staff in the context of residents’ needs and the layout of the building. On the 1st floor, one regular member of staff and one agency member of staff (on her first visit to the home) were caring for 9 residents. One of the residents was in bed recovering from a fractured pubic bone. The two members of staff had served a meal at opposite ends of the building. The permanent member of staff was attempting to show the agency member of staff what to do. In one lounge, four residents were left unattended while finishing a meal. One of these residents was incontinent of urine and was expressing distress. One blind resident was trying to locate her cup of tea and remainder of her meal. The inspector went to look for a member of staff to provide assistance. This member of staff, and other staff who expressed a view during the day, stated that staffing levels were so low that they cannot spend time talking to people. One member of staff said that this is upsetting because staff are often the only people residents have to communicate with in the absence of visitors. Overall, dependency levels were high (the manager reported that 23 of the 36 residents were classed as being high dependency). Due to the geographical lay out of the home (i.e. 7 lounge areas over 3 floors with average staff cover of 5 carers) staff expressed the view that they could not meet residents’ Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 17 needs. The layout of the home was such that when a lounge is left unattended by staff, the nearest member of staff could be at the opposite end of the building, which the manager stated is approximately 80ft away. Many of the residents spoken to had some degree of dementia and appeared disorientated and confused with resulting need for additional staffing to meet their needs. When these issues were discussed with the Manager, she agreed that staffing levels did not meet the residents’ needs. The manager stated that a structured programme of activities cannot be implemented with current staffing levels. She said that of 36 residents accommodated, 23 had high dependency levels, 9 had medium dependency levels and 4 had low dependency levels. When applying the Residential Forum Care Staffing guidelines for older people to the reported dependency levels of service users, it was apparent that the home were not delivering the minimum staffing hours. Application of the model indicated that there was a shortfall of 28 care hours per day. The Manager produced e-mails that documented her concerns about staffing levels to her line manager. She explained that she had been informed that a further 100 care hours would be allocated, but this had not been actioned at the time of inspection. At the time of the discussions regarding staffing levels a resident’s relative came into the office in a distressed state to report her mother’s allegation of adult abuse. This relative said that when she and her family visit, they care for their mother. She said that there are not enough staff to be with and observe residents. She stated ‘I, as a relative, would expect to see visible staff’. She expressed the view that family members had on numerous occasions rung the bell to get staff attention for residents other than their mother and that they have a long wait. The relative said that they do not feel that it is their job to care for other residents. A requirement was made to the effect that staffing levels must be reviewed as a matter of urgency in the context of residents’ dependency levels and the geographical layout of the building to ensure that service users’ health, safety and welfare are maintained at all times. The home was informed that the review must be undertaken by 12 May 2005 and the outcome of the review must be documented and an action plan forwarded to CSCI by 16 May 2005. Monitoring visits will be conducted to establish the progress being made in relation to these issues. Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35 and 38 The new manager was committed to raising standards at the home, but needed support to raise the standard of the service for residents. Residents’ financial interests were safeguarded but inadequate fire safety control and procedures were putting residents and staff at risk. EVIDENCE: A new manager had been appointed at the home just prior to the inspection. She acknowledged that there was much work to be done at the home, but expressed the view that she was committed to addressing all urgent requirements and to raising standards at the home. A requirement was made to the effect that an application to register the manager is made. The records of residents’ money held for safe keeping by the home had improved in response to a requirement made at the last inspection. Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 19 A requirement was made at the previous inspection concerning the need for all staff to be informed of the updated fire risk assessment and that the recommendations highlighted for action to minimise the risk of fire within the home must be actioned. In addition, the requirement stated that the home must provide a full record of fire drills. It was of concern that this requirement had not been fully actioned and further concerns about the undertaking and recording the outcomes of fire safety checks were highlighted. The date in which the above requirement should have been actioned was 31 January 2005, which had lapsed. The details of the concerns are as follows: 1. The residential officer on duty at the time of inspection could not locate the fire risk assessment and could not remember whether she had read it. Four other members of staff said that they had read a number of thick documents and they believed the fire risk assessment was one of them. None of these four staff members could recall any detail of the fire risk assessment and one said that she did not understand it when she had read it. One staff member confused this document with the fire action notices that were fixed to the walls to advise occupants of the fire assembly point etc. Fire safety checks were not being undertaken and the outcomes recorded consistently. At the time of the inspection, the most recent recorded check of the fire alarm took place on 20 April 2005. (This should be undertaken on a weekly basis). There were gaps in the records of other fire safety checks. Records of fire drills were in place but these were incomplete and it was not possible to ascertain whether all staff had taken part in a fire drill in the past 12 months. In addition, the time at which the drill took place was not noted. Therefore, it was not possible to ascertain whether night or day staff were involved in the drill. There was no evidence of fire training for the staff in the fire log book. The Residential Officer said that this is only covered once on induction. Therefore, fire safety training would not take account of any changes in legislation, change in fire fighting/location systems in the home or any revised details to the fire risk assessment. This could put residents and staff at risk. 2. 3. 4. Immediate requirements were made concerning these issues and further monitoring visits will be undertaken to check on progress. Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 1 x x x x x 3 x STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 1 2 x x x 3 x x 1 Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 and 5 Schedule 1 13 13 13 Requirement The Statement of Purpose & Service User’s Guide must be developed in accordance with NMS for Older People. The recording on MAR sheets must provide a full audit trail. Correction fluid must not be used to obscure information on the MAR sheets. The home must document their policy on recording the receipt of medication for service users in receipt of respite care. The receipt of such medication must be consistently signed for. The recording on MAR sheets must provide a full audit trail. In particular, gaps must not occur in the record so that it is not possible to establish whether medication has been administered or not and medication not prescribed or supplied must not be signed for as given on the MAR sheets. Medication details on MAR must include the times and dosage for administration. Timescale for action 19/06/05 2. 3. 4. OP9 OP9 OP9 12/05/05 12/05/05 12/05/05 5. OP9 13 12/05/05 6. OP9 13 12/05/05 Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 22 7. OP9 13 Risk assessments must be consistently in place for service users self administering medication, including insulin. Medication must be stored appropriately in accordance with pharmacists’ instructions. The advice of the pharmacist must be sought concerning the storage of Insulin (Humalin) and Phenobarbitone. To demonstrate the range of activities provided a record must be maintained. The home must ensure all service users safety in the lounges with kitchenette. The home must ensure all staff are informed of the home’s updated fire risk assessment and that the recommendations highlighted are actioned to minimise the risk of fire within the home. In addition the home must provide a full record of all fire drills. Staffing levels must be reviewed as a matter of urgency in the context of service users’ dependency levels ad the geographical layout of the building to ensure that service users’ health, safety and welfare are maintained at all times. 12/05/05 8. OP9 13 Addressed at the time of inspection 9. OP12 16 01/06/05 10. OP14 13 01/06/05 11. OP19 23 12/05/05 12. OP27 18 The review must be undertaken by 12 May 2005. The outcome of the review must be documente d and an action plan forwarded to this office by 16 May 2005. Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 23 13. OP27 18 14. OP38 23 15. OP38 23 16. OP38 23 17. OP38 23 18. OP7 15 19. OP7 15 20. OP19 23 21. OP31 8 The Home must consistently ensure that the home’s staffing levels are in line with the residential forum guidelines for staffing levels for older people. The fire risk assessment must be a working document freely available and accessible at all times. Staff must understand this document and be familiar with its content. Weekly fire safety checks must be consistently undertaken and the outcomes consistently recorded in the Fire Log Book Records of fire drills must be detailed so that it is possible to ascertain whether all staff are taking part in a fire drill in a 12 month period. In this context, the time of the fire drill must be recorded. Staff must consistently update fire training to take account of any changes in fire practice or the risk assessment. Daily reports at the home must make reference to and monitor the meeting of needs identified in the residents needs assessment and care plan. Care plans must be in place for all residents soon after admission. Care plans must be specific and must record details of the outcome for the resident, the behaviour of the resident and how their needs would be supported The home must conduct an audit of all necessary refurbishment work. This includes the redecoration and recarpeting of some parts of the ground floor area. An application for the registration of the manager must be made to CSCI. CS0000032586.V222866.R01.doc 12/05/05 and ongoing 12/05/05 and ongoing 12/05/05 and ongoing 12/05/05 and ongoing 12/05/05 and ongoing 22/05/05 and ongoing 22/05/05 and ongoing 20/06/05 09/06/05 Harry Lord House Version 1.30 Page 24 22. OP15 12 23. OP16 22(1) The nutritional needs of all service users must be met. Including having a detailed care plan and monitoring system in place. The complaints procedure must be consistently updated, all complaints must be promptly recorded in the complaints register and the manager and staff must receive training in dealing with complaints and customer service. 20/05/05 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 OP33 Good Practice Recommendations The home should attempt to ensure the quality assurance system is partially independent and is transparent in its findings. Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 Page 25 Commission for Social Care Inspection 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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 Harry Lord House CS0000032586.V222866.R01.doc Version 1.30 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!