Inspection on 02/12/08 for Hasbury

This inspection was carried out on 2nd December 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hasbury 03/12/07

Hasbury 10/07/06

Hasbury 09/02/06

Hasbury 09/05/05

Hasbury 25/01/05

Hasbury 03/08/04

Hasbury 10/02/04

Hasbury 03/10/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hasbury 154 Middleton Hall Road Kings Norton Birmingham West Midlands B30 1DN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kulwant Ghuman     Date: 0 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Hasbury 154 Middleton Hall Road Kings Norton Birmingham West Midlands B30 1DN 01214585336 01212435336 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Rajwantee Chundoo Type of registration: Number of places registered: Mrs Rajwantee Chundoo,Mr S.V. Chundoo care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Hasbury is a large, extended, detached house, which is set back from the road with car parking spaces to the front of the building. Located on Middleton Hall Road between the shopping centres of Cotteridge and Northfield, public transport passes the front of the home. Accommodation for the people who live in the home is on two floors with a passenger lift to enable access. There is a mixture of five double and fourteen single bedrooms. There is a dining room, and a sitting area that is divided into two by a dividing wall. The garden is large, with covered patio, lawn, plants and shrubs. There is a path around the garden. The property is well maintained and decorated to a high standard. The fees identified in the service user guide at this inspection were £360 to £390 per week with a top up of between £15 to £30 per week. The top up would be agreed after discussion with the manager. Care Homes for Older People Page 4 of 30 0 Over 65 24 Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: One inspector carried out this key, unannounced inspection over one day during December 2008. The last key inspection was carried out on 3rd December 2007. Prior to the inspection the manager completed the Annual Quality Assurance Assessment (AQAA) and returned it to the Commission providing us with additional information about the home. During the fieldwork visit the inspector spoke to the manager and briefly to two staff, five of the twenty two people living in the home and sampled one file belonging to staff employed in the home and for three individuals living in the home. Other documentation sampled included health and safety documents. A tour of the building Care Homes for Older People Page 6 of 30 was also carried out. There had been no complaints received by the Commission about the home. There had been one adult protection concern that had been raised but it was decided that there was no case for the home to answer. What the care home does well: What has improved since the last inspection? What they could do better: There were some improvements that could be made to the care plans and other documents relating to the care of the people living in the home such as ensuring management plans for identified risks were collated together to enable the staff to look at them quickly. Some documents needed to be dated. The daily records needed to be accurate. There were a few gaps in the records that showed that medicines had not been given and protocols needed to be put in place for medicines that could be given as and when required. New staff should remain under close supervision until all checks have been received. Some staff needed to undertake training in the safeguarding of vulnerable adults. Care Homes for Older People Page 8 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was sufficient information available to people thinking about moving into the home for them to make an informed decision about whether it was suitable for them. They or their representatives were able to visit beforehand to see if they liked it. The home carried out a pre admission assessment to ensure that they could meet the individuals assessed needs. Evidence: There was a service user guide available in the home that had been updated since the last key inspection. It had been updated to include all the relevant information. There was a service user guide available in the bedrooms of the people who lived there. The file of one person who had been admitted to the home since the last inspection was looked at. This showed us that the person had had the opportunity to visit the home before moving in. On this occasion relatives had visited on their behalf. Care Homes for Older People Page 11 of 30 Evidence: An assessment had been carried out before the person moved into the home so that the home could be sure that the individuals needs could be met. The pre admission assessment contained sufficient information to enable the home to decide if the home could meet their needs. This assessment had not been dated and it could not be determined where it had taken place. A review was carried out to ensure that the home could meet the individuals needs. A contract was given to people who moved into the home so that they knew what the terms and conditions of living in the home were. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of the people living in the home were well met. The care planning and risk assessment processes were well documented. There were some minor gaps in the recording of medicines but the people living in the home received their medicines as prescribed. Privacy and dignity were promoted. Evidence: The files of three people living in the home were looked at so that we could see if the home was able to meet their needs in a safe and individual way. One file was looked at in depth and the others briefly. The home used a care plan that gave a brief overview of the individuals needs. Areas covered in this included mobility, eating and drinking, personal hygiene, dressing, physical well being and sleep. Individual care plans were then drawn up where additional detail was needed or changes in need had taken place. The specific care plans looked at were quite well detailed but there were some areas Care Homes for Older People Page 13 of 30 Evidence: missing from some of them. For example, for one individual there was no information about oral or nail care. However, there was also some very good detail, for example, the way in which staff were to approach an individual as the tone and loudness of voice could upset them. Care plans were reveiwed on a monthly basis and on a regular basis relatives were involved in these reviews. On the day of the inspection some relatives were present at a review. There were risk assessments in place. The risk assessments were very long and although lots of areas were covered it was unlikely that staff would read all the way through. The mobility risk assessment resulted in a personal handling plan that had some very good detail about what staff had to do. For example, where an individual needed help to stand up and transfer to another chair there was good detail about the placement of the chair in relation to the individuals legs. The personal handling plan could be improved by ensuring that it was dated and the number of staff needed was clearly identified. Other risks covered included nutrition, pressure ulcers and falls. The pressure risk assessment for one individual was discussed. It stated that the individual was very likely to develop pressure ulcers. There was no recorded reasons for how this had been arrived at. The actions to be taken identified clearly what steps needed to be taken if pressure ulcers had developed but there was nothing recorded as to what actions needed to be taken to prevent the ulcers developing for example using a pressure cushion to sit on. It was recommended that an assessment such as the Waterlow assessment was undertaken which would show how the risk had been identified as being low, medium or high. One of the falls risk assessments was also looked at. The individual was able to use the stairs independently and there had never been a fall in the home. In discussion with the manager we learnt that she felt the individual was at risk of tripping, or missing a step. However, anyone could trip or miss a step but that would not mean that they were at any particular risk of falling. During further discussions it came to light that the real concerns arose when the individual was at a low mood and was not very co ordinated. The risk assessment needed to highlight that this was when there was a risk but at other times the individual was quite able and the risk was an acceptable risk for them to take. If in the future the individual did start to have regular falls then this would have to be re assessed and the appropriate actions taken. It was advised that it would be better if all the identified risks and management plans could be identified on one or two pages rather than the individual sheets that the staff Care Homes for Older People Page 14 of 30 Evidence: would need to look through to get an overview of each persons risks. The risk assessments and care plans should be linked so that staff were made aware that they needed to look at both documents to ensure they had the full details of how peoples needs were to be met. The health care needs of the people living in the home were met by referral to a number of professionals including psychiatrists, general practioners, district nurses, chiropodists, opticians and dentists. People were assisted to attend hospital appointments where needed. Good records were kept of the contacts with the medical professionals. People were weighed however sometimes these were not regular and when there was an unusual weight it was not checked to clarify it was the correct weight or an error in recording. In one of the files looked at the individual appeared to have put on two stones in weight but this was not questioned. One of the people whose care was being followed did not have a social care plan in place although the others did. The particular individual did not like to get involved in activities in the home except church services and sitting with relatives. There were no indications that the privacy and dignity of the people living in the home were not being promoted in the home. Bedroom doors had locks on them, there was a lockable piece of furniture in the bedrooms and there were screens available in shared bedrooms. The management of medicines in the home was generally good. The new medication period had started a couple of days prior to the inspection so it was not possible to check against the blister packs. Previous medication administration records (MAR) were looked at. The medicines were appropriately booked in and copies of prescriptions were available enabling staff to check that the correct medicines had been received. There were occassional gaps on the MAR charts, however, as the medicines were in blister packs it was likely that the medicines had been given but staff had failed to record this. It is important that staff fully complete these charts as they are legal documents and showed whether an individual was receiving their medicines as prescribed. The controlled medicines were loooked at and it appeared to be satisfactory. The home had identified on a couple of occasions an error had been made in recording and this had been rectified. The home was carrying outaudits of boxed painkillers twice a day. It was suggested Care Homes for Older People Page 15 of 30 Evidence: that this could be reduced to weekly and if any discrepancies were identified that audits of staff administering the medication could be carried out. The returns book showed that medicines being returned to the pharmacist were being recorded ensuring a full audit trail for medicines. There were some medicines that were to be given as and when required when some behaviours were being shown by someone living in the home. The manager needed to ensure that there was a protocol in place to ensure that these were given consistently by staff. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home could generally decide when they got up or went to bed. There were activities available both within the home and outside to meet the social needs of individuals if they wanted to take part. Friends and relatives were welcome in the home. The people living in the home were happy with the food available. Evidence: The AQAA told us that the home carried out regular meetings with the people who lived in the home and there was a suggestions book in place. There were minutes of four meetings within the past 12 months. These discussed issues such as activities, laundry, complaints, menus, celebrations and trips out. Comments friom these meetings included: We are happy with the laundry. Happy with the meals. No complaints, very happy and X said she had to get up too early but X (staff) said she didnt get up until breakfast time and she would miss it if she got up any later. This was not a suitable response and appears uncaring and abrupt. The matter was raised with the manager who said she would address the issue. Some trips had been organised for example a meal out, a pantomime and to see the Christmas lights in Birmingham. Care Homes for Older People Page 17 of 30 Evidence: A relative had made a suggestion about having a communication book for them to write in to be left in a public area. The manager had agreed to this but had made people aware that personal information was not to be included. It may be more appropriate to have individual books for the people living in the home. There was evidence that people had been out to go bowling, there were exercise sessions, some people liked to attend church serivces, some people went out for coffee. There were some entertainers who came into the home to entertain the people living there. One of the completed surveys said There has recently been a difficulty in that a person who led activities left during Summer 2008 and it seems has not been replaced. Relatives were welcome in the home at all reasonable times and they were seen to come and go during the day. Relatives were invited to celebrations such as birthdays and the Christmas party. The people seen during the day said that they enjoyed their meals. The inspector was able to join the people living in the home for tea. There was a choice of sandwiches available. There were plenty of sandwiches available, there were some crisps available in a bowl on the table. Sugar was available on the tables. Tea was poured out by a member of staff. The people living in the home seemed to enjoy the meal with a lot of chattering going on with the staff. Three completed surveys told us that they enjoyed the meals provided. There were records of what people ate at tea time and at lunchtime. There were no records for breakfast or supper. It was advised that records needed to be kept of these also. There was a list in the kitchen identifying what people liked to have for breakfast. There was none identified as liking to have a cooked breakfast. We were told that some people did have some cooked foods such as eggs at breakfast but there were no records kept of this. One person told us that although she could not remember what she had eaten at lunchtime she did remember that she enjoyed it. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home were safeguarded by the policies and practices in the home. The people living in the home and their representatives were listened to and actions taken where appropriate. Evidence: No complaints had been received by us and there were no major issues raised at the home. Any issues raised at the home were dealt with appropriately and there was normally a written response to the person raising the issue to tell them what the home had done in response. One of the completed surveys told us that a complaint made was immediately followed through and investigated fully. There was a complaints procedure in place and the procedure was discussed in meetings with the people living in the home. One adult protection issue had been raised at the home by paramedics attending the home. The issue was looked into by the social services team and no matters were found that the home needed to address. Care Homes for Older People Page 19 of 30 Evidence: Staff at the home were having adult protection training with about half aready having undertaken it. It was important that the others also undertook this training. The recruitment procedures ensured that all the required checks were undertaken to ensure that only suitable people were employed to look after the people living in the home. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided the people living in the home with a warm, clean, comfortable environment in which to live. Adaptations were in place to help people with specific needs. Bedrooms were comfortable and personalised. Evidence: During the inspection some of the communal areas of the home were seen as were two bedrooms and two bathrooms. The home was suitable for the needs of the people living in the home. It was well maintained, clean, comfortable and homely. The dining room had had new wood flooring, table and chairs, and furnishings including curtains replaced. Part of the lounge had had hard flooring and part had had new carpet laid. Some new armchairs had been purchased. The communal areas of the home were comfortable and homely. The bedrooms seen were personalised to the liking of the occupant. There was suitable furniture and bedding in place. The heating and lighting were adequate. Screening was Care Homes for Older People Page 21 of 30 Evidence: available in shared bedrooms. We were told that several bedrooms had had carpets replaced. There were a number of communal toilets and bathing facilities throughout the home that had appropriate adaptations to enable individuals to be assisted safely. At the last inspection it was noted that the emergency call system was not available in the toilets and bathrooms. This had been attended to, it was now available in all rooms in the home. There were other adaptations in the home including handrails, hoists and a passenger lift. A new hoist had been purchased for use in the home. The home was found to be clean and hygienic and there were no odours evident providing a pleasant environment for everyone. One of the general practioners for the home had suggested having antiseptic handwash by the front door and by the toilets. During the tour of the building it was noted that a number of the bedroom doors were wedged open. When the staff closed one of these the person occupying the room shouted out that they wanted the door to be left open. The manager needed to set up a system that enabled people to keep their door open but that also ensured that the doors would shut automatically in the event of a fire to keep the people in their bedrooms safe. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels and the training provided meant that the needs of the people living in the home were safely met. The recruitment procedure was good however, people being employed must be supervised at all times until all the checks have been received. Evidence: There were sufficient staff on duty in the home to meet the needs of the people living there. In addition to care staff the cook, domestics and manager are available. There was a vacancy for an assistant in the kitchen and a domestic. These posts were to be filled in the new year. An activities co-ordinator is being employed as the previous one has left. There had been little staff turnover at the home and this provided good continuity of care for the people living in the home. Staff are representative of the local community and a broad age range. One staff file was looked at to assess the recruitment process in the home. All the appropriate checks were in place but this individual had started their induction prior to the POVA first check having been received. We were told that the manager was with Care Homes for Older People Page 23 of 30 Evidence: the individual during that period. They started employment when the POVA check had been received however, it is important that the individual does not work unsupervised until the full CRB is received. The training matrix at the home showed that the staff were receiving regular updated training to ensure that they had the skills and knowledge to carry out their roles. There was an ongoing programme of updating the staff training. Over fifty per cent of the care staff had at least completed NVQ Level 2. Some have also undertaken NVQ Level 3. Fire training for staff was overdue and it had been arranged for January 2009. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was managed well and the needs of the people living in the home were paramount. The health and safety of the people living in the home, visitors and staff were managed well. Evidence: The manager of the home had many years experience of running a care home. She had the qualifications needed to provide her with the skills and knowledge to manage the home. She had good skills in record keeping and had a good knowledge of the needs of the people in her care. The manager was very receptive to the comments made during the inspection to help improve some areas. Many of these actions had been taken by the day after the inspection. A quality assurance system was in place that took into account the views of the people living in the home, their representatives and professionals who visit the home. A plan was drawn up of what actions are to be taken during the following year to improve the Care Homes for Older People Page 25 of 30 Evidence: home. We were told that the home did not handle any monies on behalf of the people living in the home. Some people held small amounts of money themselves. There were no significant health and safety issues arising during the inspection. The only issues arising were occasional gaps in the medication records, the wedges in use around the home and ensuring that people were not left unsupervised in the home until the CRB had returned. The manager keeps us aware of any incidents that happen in the home. She also keeps a log of any incidents occuring so that she can monitor them and keeps the families of the people living in the home informed. Health and safety in the home was well managed. The fire records were checked and showed that the checks were carried out at the required frequencies. The AQAA told us that the equipment in the home was serviced on a regular basis. This ensured that the home was safe for the people living there, the staff and visitors to the home. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 15 12 People wishing to get up 31/01/2009 later in the morning must be able to have breakfast later in the day. This will enable the people living in the home to have some control on their daily routines. 2 29 9 The manager must ensure 31/01/2009 that people employed before the CRB has been received are not left to work unsupervised. This will ensure that the people living in the home are safeguarded. 3 38 23 The manager must ensure that a system is put in place that enables bedroom doors to be kept open but that will shut them in the event of a fire. 31/01/2009 Care Homes for Older People Page 28 of 30 This will enable those people who want to keep their bedroom doors open do so safely. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 7 Pre admission assessments need to be dated and state where they are carried out. Personal handling plans should be dated and clearly show the number of staff needed to assist the individual. This will ensure that plans can be updated and staff will know what assistance is needed. All identified risks and management plans should be collated together so that staff needed to refer to only one document. This would ensure that the staff would be aware of all identified risks and the management plans for them. A waterlow assessment should be carried out. This will ensure that there is a rationale to the risk levels given in the home to people who are at risk of developing pressure sores. The manager must ensure that any unexpected weight gains or losses are double checked so that the appropriate referrals can be made if needed. The manager must ensure that there are no gaps in the medication records. This will ensure that the people living in the home get their medicines as prescribed. The manager needed to ensure that there was a protocol in place to ensure that medicines to be givne as and when were required were given consistently by staff. A system should be set up that enables the food eaten at breakfast and for supper to be recorded. This will enable the total diet of people living in the home to be assessed for variety and nutrition if needed. Staff who have not yet undertaken adult protection training should undertake this. This will ensure that all the staff will know their roles in safeguarding the people living in the home. 3 7 4 8 5 8 6 9 7 9 8 15 9 18 Care Homes for Older People Page 29 of 30 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - 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!