Inspection on 15/08/05 for Haughgate House Nursing Home

This inspection was carried out on 15th August 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

Haughgate House Nursing Home 18/08/08

Haughgate House Nursing Home 14/08/06

Haughgate House Nursing Home 16/11/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Haughgate House Haugh Lane Woodbridge Suffolk IP12 1JG Lead Inspector Kevin Dally Announced 15 August 2005 th 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. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Haughgate House Address Haugh Lane, Woodbridge, Suffolk, IP12 1JG 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) 01394 386249 01394 386249 None Haughcare Ltd Penelope Hull Care Home 17 Category(ies) of Old Age (OP) 17 registration, with number of places Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 10/03/05 Brief Description of the Service: Haughgate house is a converted home, with a modern extension, and extensive gardens. There is accommodation for seventeen service users with medical nursing needs but currently there is a building programme underway to add an additional 14 beds to the home. The Home is located on the outskirts of Woodbridge, close to the A12. All services can be located in the centre of Woodbridge, which is approximately 2.5 miles away. All bedrooms in the extension are single rooms and an assisted bathroom and separate laundry are available in this part of the Home. One double room is available in the main house along with a large dining room, sun lounge, treatment room, kitchen and a further two bathrooms, one of which is assisted. All bedrooms and communal areas for service users are on the ground floor with level access to all areas. Since the recent sale of the home, the first floor accommodation has been converted into office space for the owners, the manager, and for use as a training room. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report followed a routine announced inspection of Haughgate House a care home offering nursing care, and was carried out over a 9 hour period on a weekday between 9.30am and 6.30pm. Ms Penny Hull the manager, and Mr and Mrs Carter the new owners, were present throughout the day and were available to answer any questions. 6 residents, 1 relative and 3 support workers were spoken with about the service. 9 comment cards were received from residents or relatives. Residents, staff and administration records were checked and a brief tour of the premises was completed. This inspection revealed that of the 32 standards inspected, 29 were assessed as fully met, 2 standards as almost met, and 1 standard as not met. Further, that the home continued with the positive provision of a nursing care service to residents with medical problems. What the service does well: What has improved since the last inspection? In May 2005 the home was purchased by Haughgate Care Ltd, and their application to register with the CSCI, was successful. This inspection demonstrated that positive changes were already evident, which included the commencement of a building programme to add an additional 14 beds to the home. The owners had established positive dialogue with residents, relatives and the staff group, and had kept them informed of the expected changes ahead. Further, the owners were providing positive support to the manager, and are dealing with some of the more burdensome administrative tasks. This would allow the manager to focus more on nursing related issues. Administration and recruitment practices are under review and record keeping practices were being updated. Previous inspection shortfalls, including gaps in the hallway floor and radiator protector covers, had now been attended to. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 6 What they could do better: 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. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 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 standard(s) 1,2,3,4 People can expect that they will receive informative and helpful information about the service provided. People can expect to have their care needs assessed prior to admission, and will know whether or not the home is able to meet their needs. EVIDENCE: The home had an informative Statement of Purpose and Service User Guide, which described for each prospective or current service user the key points about the home. These had recently been fully updated by the new owners, and were available for reading at the main entrance of the home. New residents would be offered the home’s contract, which detailed for them the conditions of their residence. During the inspection two resident’s records were examined and these contained detailed Stars Assessments, which assessed 30 areas of personal need. Using the nursing process, significant needs identified from the Stars assessment would be used to construct the care plan. One of the service user’s relatives was spoken with and they were able to confirm that the care received by their relative met their needs, and was very good. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 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 standard(s) 7,8,9,10 People can expect to receive good quality nursing care, although care plans which identified complex nursing care needs, would not provide sufficient details or adequate risk assessment of this care. Based on service users comments, people can expect to be treated with respect and be encouraged to maintain their independence. EVIDENCE: Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 10 Two residents with complex care needs were identified, and their care tracked. Care plans were developed from the use of a Stars Assessment, which assessed 30 areas of personal need. Using the nursing process, significant needs identified from the Stars Assessment only are recorded. The nursing process included identifying the problem and/or nursing need, aim, nursing action, and the continuation sheet. The care plan of a resident, who experienced a high number of falls, was checked. Their care plan included assessment details under the headings, continence, personal care, mobility, monitoring [a medical condition], night needs, nutrition, social contact and stimulation. Care records identifying the specific element of mobility [falls] were tracked and were found to be basic. Whilst the resident had experienced around 124 falls, the care plan stated “mobility –tendency to fall”, and did not appear to detail the complexity of the problem, or identify existing measures that were in operation to manage the problem. In discussion with the manager, and from the records it was clear that many of the falls were minor in nature, and that falls monitoring was in place. Further, that the home had implemented a number of measures (see below) to improve things. However these various strategies to manage this problem had not been clearly identified or included within their care plan. The moving and handling risk assessment was also checked and found to be basic, and which did not fully detail the complexity of the falls problem, or how these should be monitored. The care records of a second person with complex care needs around nutritional and weight problems was checked. Problems identified by the care plan were around incontinence, personal care needs, pressure areas, nutritional issues, skin problems, lack of mobility, sleep and communication problems. The nutritional care element of this care plan was tracked, and as before, the care plan was found to be basic in detail, which did not clearly identify all the nutritional issues, including weight loss. Additional supporting information included a recently commenced MUST nutritional monitoring assessment, and this demonstrated that there were serious nutritional concerns. However, the home had appropriately referred these problems to the dietician, and advice was received, and followed. Of concern was that the resident’s weight had only been infrequently monitored from April 2005. The home had a sheet called an ‘Accountability sheet’, which identified the accountable nurse for each shift, and once signed by the nurse, meant that all identified care had been given to residents, as per their care plan. If there had been no significant changes or observations for that service user, then no other recording was required. Any significant changes would be recorded on the evaluation section of the care plan. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 11 Although care plans were updated when required, daily records of care maintained, and the accountability sheet signed for, records confirming monthly care plan reviews were difficult to track. The home’s management of one residents falls were further discussed with the manager and although it was not clear from the records (as discussed above) it was revealed that a variety of positive strategies had been implemented to deal with these issues. These included assessment before admission, risk assessment, a review meeting with appropriate professional staff, and their family. Further, application of an appropriate protection appliance, a call bell located on their wrist, visits from the community physiotherapist, advice received from the Occupational Therapist, and a visit from the falls coordinator. A referral had been made to the falls clinic. From questionnaires received from residents and discussion with a group of residents, it was confirmed that the home provided good care and support. Comments from relatives included, “nurses and carers are consistent of patients individual needs” and “the care is very good. Residents are [offered personal care] regularly and are [always looked after]. Further, residents stated that staff had consulted them about the care they required. The homes medication system was checked and this revealed that medication was normally stored in either the medication cupboard or mobile trolley. Registered nurses would administer medication directly from resident’s prescribed packets or bottles to the resident. Medication records examined were well maintained with no gaps in administration records, and staff were observed administering medication in a safe manner. The home’s medication policy was checked and this required further development and guidance for staff to include the details of what arrangements are in place around the recording, handling, safekeeping, safe administration, self administration, and disposal of medicines received into the home. Policy must identify who is responsible for each task, and whether there are any special requirements around the administration of specialised medication, for example insulin. Residents and relatives spoken with, and residents questionnaires received confirmed that staff respected users privacy, and provided care in a supportive and dignified manner. The 3 returned residents surveys received confirmed that they were well cared for, were treated well and that their privacy was respected. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 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) 12,13,14,15 People can expect a lifestyle that enables them to participate in personal, social and leisure activities within the home, should they choose to do so. Relatives and friends can expect to be made welcome when visiting the home. Residents can expect to receive meals that are nutritious, balanced and meet their needs. EVIDENCE: Discussion with a group of service users and the staff confirmed that service users are able to follow their own routines, and a variety of leisure and personal pursuits. 5 service users informed the inspector of the various times they chose to rise in the morning and that staff would respect their requests to remain in bed should they so choose. Service users and staff spoken with at the inspection confirmed that the home had varied recreation opportunities, and included various games, music, gentle exercises, walks and local visiting group. Meal times are as flexible as possible and residents are able to choose where they eat their meals. Residents records examined evidenced that individual interests, likes, dislikes and preferences are documented under “My Favourite Things”. The manager and staff confirmed that provision was given for care staff to spend time with residents in the afternoon. Families, friends and representatives are welcomed at the home, and one resident was receiving a visitor on the day of inspection. This relative Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 13 confirmed that there was a good atmosphere at the home, that the care was good, and that there were always activities and things for residents to do. The home had redeveloped a four week rolling menu, which offered residents a well-balanced, varied and nutritious diet. The meal on the day of the inspection looked and smelt appetising and was attractively presented. This was sausage pie, mashed potatoes, Swedes and cabbage. Dessert was treacle sponge pudding and custard, or fruit sponge. The home also offered a variety of alternative hot options. Blended meals were offered to those requiring soft diets and components were liquidised and served separately on the plate to maintain a variety of textures, flavours and colours. Some residents choose to eat in the dining room, although meals could be taken in their rooms if they wish. Drinks were available throughout the day and the lunchtime meal was unhurried with sufficient time given to residents to eat in comfort. The evening menu provided a good variety of choice, and was a lighter meal. For example, corned beef sandwiches, mushroom soup, pilchards on toast and yoghurt. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 14 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) 16,17,18 People can expect to have their complaints taken seriously and acted upon. Resident’s safety, through methods such as appropriate training and recruitment checking, can be expected. EVIDENCE: The home had a complaints policy, which included appropriate details about how a complaint can be made to the home or the CSCI. The home had a complaints book in operation, and had three recorded complaints within the last twelve months. These complaints were minor in nature, and had been responded to by the home. Resident and relative questionnaires indicated that most people know about the complaints procedure and who to complain to if they are not happy. One relative of five commented that they had made a complaint to the home, but that “they would like to see repair work completed quicker”. On the day of inspection six residents spoken with said that they felt safe at the home and felt confident that they could talk to someone, if they had any concerns. Care staff training records included abuse awareness and staff spoken with confirmed that they had training, and had an awareness of protection of vulnerable adults procedures. Two staff records were examined, and both included Criminal Bureau Record checks (CRB), and records of those staff members having received adult abuse training. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 15 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) 19,20,21,22,23,24,25,26 People can expect a safe well maintained environment, which would be clean, hygienic, and odour free. They can also expect to have the aids and equipment to meet their individual needs. EVIDENCE: Haughgate house is a converted home, with a modern extension, and extensive gardens. There is currently accommodation for seventeen service users with medical nursing needs. All bedrooms and communal areas for service users are on the ground floor with level access to all areas. The first floor area now provided office space for the owners and the manager, and a training room for the staff group. All bedrooms in the extension are single rooms, and an assisted bathroom and separate laundry are available in this part of the home. One double room is available in the main house along with a large dining room, sun lounge, treatment room, kitchen and a further two bathrooms, one of which is assisted. Currently there is an extensive building programme underway to add an additional 14 beds to the home. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 16 A brief environmental tour of the premises concluded that resident’s personal rooms were well decorated, comfortable, and maintained. Corridor areas had been repainted, as had been the dining room, with the provision of new chairs. The home had a variety of aids, adaptations and a new wireless call bell system. Previous inspection shortfalls, including gaps in the hallway floor and radiator protector covers, had now been attended to. On the day of the inspection the home was found to be clean, hygienic and odour free. The bathrooms, toilets and bedrooms seen were provided with liquid hand wash and paper hand towels. Residents and staff confirmed that the home was maintained in a clean and hygienic state. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 17 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) 27,28,29,30 People can expect that the home will be appropriately staffed but that staff may be stretched during some busy morning periods. People can expect effective staff recruitment, training and supervision procedures. EVIDENCE: The home endeavours to ensure that there was one nurse on duty each shift, with 3 care staff on an early, 2 on a late, and 1 at night. Although staffing levels had been appropriately maintained throughout the 24 hour period, three relatives made comments around their concerns about staff being stretched during some morning periods. In discussion with the manager it was evident that there have been some periods where staff have been stretched due to staff sickness or annual leave. This had also sometimes impacted on the manager who has had to spend more time covering duties, than undertaking her management responsibilities. Two staff member’s recruitment records were examined and suitable recruitment and employment procedures were found to be in place. Staff member’s records included appropriate Criminal Record Bureau (CRB) checks, application forms, photos, and identity records on file. One staff member’s records did not have a copy of their references. This was discussed with the owners who stated that during the purchase of the home, the former owner had lost a number of his employee’s references. It was agreed that where this situation applied, that the owners must obtain one character reference for those employees, and maintain a second letter stating how these records had been lost. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 18 Care staff training records and staff spoken with confirmed that they received training relevant to the care needs of the service user group. Examples of recent training for carers included moving and handling, first aid, adult protection training, fire, nutritional care, feet care and NVQ foundation training. One staff member confirmed that they had completed NVQ 2 training and another confirmed that they were currently training towards this award. Training received by registered nurses, was not examined on this occasion. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 19 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) 31,32,33,36,38 People can expect a well managed home that has an honest and open atmosphere. They can also expect a safe environment. EVIDENCE: In May 2005 the home was sold to and purchased by Haughgate Care Ltd, and their application to register with the CSCI, was successful. This inspection demonstrated that positive changes were already evident, which included the commencement of a building programme to add an additional 14 beds to the home. The owners had established positive dialog with residents, relatives and the staff group, and had kept them informed of the expected changes ahead. Further, the owners were providing positive support to the manager, and are now sharing some of the more burdensome administrative tasks. This allowed the manager to focus more on nursing related issues. Administration and recruitment practices are under review and record keeping practices were being updated. Previous inspection shortfalls had been attended to. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 20 Of concern during this inspection was the number of hours that the manager had recently been working within the home. This was discussed with the owners and the manager, who confirmed that this had been due to recent sick leave and annual leave. However, the manager stated that she felt very supported by the new owners, and it was acknowledged that appropriate management hours would be set aside to address these concerns. Residents, relatives, and staff spoken with confirmed that the management were very approachable, and were keeping them in touch with all new developments, including the new extension. Staff particularly identified the very positive changes that they had seen over the past two months, and stated that they felt supported by the new management. Residents stated that even though the building site could be disruptive at times, they were very pleased that the home was being modernised, and were prepared to be tolerant, while these changes were completed. Staff spoken with and records checked revealed that supervision was undertaken for care staff. Records confirmed that staff had received moving and handling training, and manual handling risk assessments had been undertaken for residents. Records revealed that fire alarm checks had been maintained, and that water temperatures had been routinely checked. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 21 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 3 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x x 3 x 3 Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 22 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. 2. Standard 7 7 Regulation 15(1) 15(1) Requirement Care plan summaries must identify all key areas of concern. Care plans must provide full details of complex care issues, including the measures to be undertaken to manage these problems. Moving and handling risk assessments must identify all mobility risks to residents, including falls, and must state how these are to be managed, and the risks reduced. Regular weight monitoring must be undertaken for vulnerable residents and a record maintained of their file. A risk assessment management strategy must be undertaken for one resident vunerable to weight loss. This assessment must record the risks, and identify the strategies for care, that will be followed. Medication policy must be updated to provide more guidance around the recording, handling, safekeeping, safe administration, self administration, and disposal of Timescale for action 12/09/05 12/09/05 3. 7 13(4)(b) (c) Immediate 4. 7 5. 7 13(4)(b) (c) Schedule 3(3)(k) (m) 13(4)(c) Schedule 3(3)(k) (m) Immediate Immediate 6. 9 13(2) 1/11/05 Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 23 7. 8. 27 29 10(1) 19(1)(b) (i) Schedule 2(5) medicines received into the home. Policy must identify who is responsible for each task, and whether there are any special requirements around the administration of specialised medication, for example insulin. The manager must ensure that 12/09/05 they have sufficient hours to manage the home. Where employee references have 1/11/05 been lost, a character reference must be obtained, and a second letter maintained of their record stating how these records had been lost. 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. 2. 3. Refer to Standard 7 7 27 Good Practice Recommendations The manager should consider alternative ways of recording monthly care plan reviews, and not just via the accountability sheet. The manager should consider more regular reviews of pressure are risk assessments. The manager should review the placement of staff to ensure sufficient staff levels during busy morning periods. Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 5th Floor, St Vincent House Cutler Street Ipswich IP1 1UQ 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 Haughgate House I54-I04 S63952 Haughgate House V236107 050815 Stage 4.doc Version 1.40 Page 25 - 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!