CARE HOMES FOR OLDER PEOPLE
Hays House Sedgehill Shaftesbury Dorset SP7 9JR Lead Inspector
Susie Stratton Unannounced 10th June 2005 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. Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Hays House Address Sedgehill Shaftesbury Dorset SP7 9JR 01747 830282 01747 830005 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) Park Healthcare Limited Mrs Catherine Maureen Sheppard Care Home with Nursing 43 Category(ies) of OP Old Age (43) registration, with number TI Terminally Ill (1) of places Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No more than 1 person in receipt of terminal care at any one time. 2. No more than 43 service users with Old Age at any one time. 3. There are staffing conditions as agreed following the serving of the Notice of Proposal of 01 October 2002. Date of last inspection 24th January 2005 Brief Description of the Service: Hays House is an old country house, parts of which date back to the early Victorian Era. The home is situated in eight acres of grounds and accommodation is provided over four floors. A new purpose built wing was completed in the summer of 2002 and provides ground floor accommodation to the rear of the building. At the time of the inspection, there were 39 persons resident in the home and one vacant bed. The home is owned by Park Healthcare Limited and the responsible individual is Mr R Clarkson, who visits the home on a regular basis. The registered manager of the home is Mrs Catherine Sheppard, she is supported by a team of registered nurses, care assistants, administrative and ancillary staff. The home is situated off the A350, between the villages of Sedgehill, East Knoyle and Semley. It is 3 miles north of Shaftesbury and 8 miles south of Warminster. The nearest railway station is in Gillingham, Dorset. Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on a Friday between 11.35am and 5.15pm, in the presence of Mrs Sheppard, registered manager. During the inspection, the Inspector met with two registered nurses, one of whom was newly employed, five care staff, one of whom was newly employed, the activities coordinator and the administrator. The Inspector met with seventeen service users and observed the care of nine service users who were not able to communicate, she also met with three relatives. The records of seven residents were reviewed in detail and their care needs discussed with the registered nurses and Mrs Sheppard. The Inspector observed one mealtime and two activities groups taking place. She reviewed the fire log book, maintenance records, supervision records and the files of two recently employed staff. What the service does well: What has improved since the last inspection?
Systems have been put in place to ensure that “found”/dropped tablets are disposed of properly and records maintained. Systems also ensure that limited life medicines are not used after their expiry date. Improvements have been made to assisted bathing facilities on the first floor ahead of the compliance date and work is underway to put a sluice room on that floor. All bed bases have been replaced. Clinical waste is now put in foot-pedal operated waste bins. The home has established systems to ensure that underwear is not used communally. A full written audit trail for valuables handed in for safekeeping at weekends had been put in place and staff showed an awareness of proper temporary storage for such items. Where oxygen is in use, correct signage is
Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc Version 1.30 Page 6 in place. An action plan has been developed and will be actioned during the summer to install supplementary heating in bedrooms, to prevent the use of portable heaters. Contact points have been placed on all external fire doors, which alarm if they are opened, to alert staff and ensure the safety of residents and staff. Of the twelve requirements identified at the previous inspection, ten have been met in full and one is in progress but not yet due. Of the eight recommendations, seven have been met and Mrs Sheppard is setting up systems to ensure that the other one will be met in future. 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. Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc Version 1.30 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 Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc Version 1.30 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, 3, 4, & 5. The home does not provide intermediate care, so standard 6 is not applicable. Hays House provides information to residents and their supporters prior to admission and pre-admission visits are encouraged. Residents have a full assessment of their needs prior to and after admission to the home. Hays House is able to meet the needs of residents in the home. EVIDENCE: Hays House has a comprehensive statement of purpose and service users’ guide, which are made available to service users and their supporters. Both documents include all required information. Service users are assessed by Mrs Sheppard prior to admission and further assessments are made, following admission. Two registered nurses said that while some assessments could be made immediately after admission, a full assessment of residents’ individual care needs could not be completed until they had been in the home for a few weeks and staff had got to know them individually. Residents spoken with said that while they had been too unwell to visit the home prior to admission, a member of their family had done so on their behalf. Residents said that the home could meet their nursing and care
Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc Version 1.30 Page 9 needs, this was supported by discussions with staff and reviews of care provision. One resident said “When I need help, they give me the help I need.” Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.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, 8, 9 & 10 While service users are protected by up-to-date practice and documentation in some areas of care, there continues to be a lack of consistency in care planning for some residents. This could put these residents at risk. Staff demonstrated that they knew residents well and individual needs for privacy and dignity were met. Most systems for safe administration of medicines are in place, but some residents may be put at risk, as the home cannot demonstrate that certain residents have been administered their prescribed medicines. EVIDENCE: All residents at Hays House have nursing and care records completed. Where risks are identified, care plans are meant to be developed to direct staff on how risk is to be reduced. These care plans are variably completed. Seven of the residents were assessed as being at risk of pressure damage but four did not have a care plan directing staff on how risk was to be reduced. One of these residents did not have relevant equipment on their bed, staff knew the reason why this was, but the reasons were not documented. Five of the residents were assessed at being at nutritional risk, three had care plans directing how risk was to be reduced, but two did not. Four of the service users had safety rails on their beds, two had care plans relating to this, two did not. Of the seven records reviewed, two had not been reviewed regularly
Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc Version 1.30 Page 11 although some care needs had changed. Some of the residents’ records are difficult to review, as care plans from a period ago, which are no longer relevant, are included in records. It was noted as good practice that where one resident was assessed as being at risk of skin tears, that a care plans was in place to reduce risk. Discussions with staff indicated that very few residents in the home did not have continence care needs and the home manages these care needs in accordance with to current research- based evidence and it was noted as good practice that none of the residents’ continence was managed with the use of a urinary catheter. One resident who had additional mental health needs had clear records directing staff on the management of these needs. Hays House has a well-established key worker system in place and both registered nurses and care staff showed a very detailed knowledge of their residents’ individual nursing and care needs. Hays House cares for some very frail residents. Frequent care charts are used to monitor care provision for such residents. The charts reviewed had all been completed and there was evidence that where one chart had not been fully completed a few days before the inspection, that this had been noted. Staff clearly called residents by their preferred names. All staff knocked on bedroom doors prior to entry and all care was provided privately. A system has been put in place to ensure that underclothes, particularly net underwear and “pop” socks are not used communally. The system for marking of residents’ clothes has improved since the previous inspection and the container for unnamed clothes in the laundry now contained very few items. Hays House has clear systems for documenting drugs received into the home. Following changes in legislation, Mrs Sheppard is developing new procedures for disposal of drugs. There were numerous occasions where registered nurses have had to complete instructions by hand, including one for Temazepam, a schedule 2 drug. Such records had not been signed and countersigned by a second person, to verify that the GP’s instructions had been correctly documented. Mrs Sheppard reported that she is seeking to change their supplying pharmacist, to address this issue. A total of 30 individual medicines administration records had not been completed, nearly all of these related to two particular shifts and therefore are likely to relate to one member of staff. If medicines’ administration records are not completed, the home cannot demonstrate that the resident has taken their drugs and if not, why not. Two residents had particular needs for medicines administration, one liked one particular drug to be left with them and another reported a need for certain drugs which their past records and their GP regarded as not applicable. Staff spoken to were fully aware of both situations, however this was not supported by records, so a member of staff who was unfamiliar with the situation might take actions, which would not meet the individual’s care needs.
Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.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, 13, 14 & 15 A range of recreational activities are offered to residents and their spiritual needs are supported. Visitors are encouraged. Service users reported that they could choose how their spent their days. Meals are attractively presented and residents said that they enjoyed them. EVIDENCE: The activities co-ordinator was observed to be running two different group sessions during the inspection. Residents attending them contributed to the sessions with enjoyment. A local vicar was in the home, offering a religious service to residents who wished to attend. The different sitting rooms were observed to be being used by a variety of different residents and their visitors throughout the inspection. One residents said “There’s plenty of people to talk to here.” Some residents said that they preferred to remain in their rooms and this was respected. Residents said that it was up to them when they got up and went to bed. Residents are supported in bringing in a range of their own possessions if they wish and some of the rooms were very personal. Relatives said that they could visit when they wished. Two commented on how well the home kept in touch with them to inform them of matters relating to their relative.
Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc Version 1.30 Page 13 Residents all reported that they appreciated the meals, that they were given a choice and could say what size of portion they wanted to be given. Residents described the meals as “excellent” and “wonderful”, one resident said that their lunch had been “jolly nice” and another that they appreciated being given a choice of different drinks. Meals were well organised. Many residents ate their meals in the dining room and others in their own room. Where residents needed assistance to eat their meals, staff sat with them, supporting them. Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc Version 1.30 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 The home has a complaints procedure, which works in practice. Residents were supported in voting if they wished. Residents are put as risk as not all registered nurses are aware of their responsibilities for reporting abuse under the local vulnerable adults procedure. EVIDENCE: The home’s complaints procedure is displayed in the main entrance hall. Residents spoken with all knew how to bring up issues of concern. One resident said they spoke to “Matron” if they had a problem, another said they spoke to their key worker and another to “one of the girls in blue”, meaning a registered nurse. None of the residents spoken with were able to recall the general election. Mrs Sheppard reported that she had applied for postal votes for all the residents and that those residents who had wished to, had voted. Staff spoken with were very aware of the potential vulnerability of residents in the home, however one newly employed registered nurse had not been trained in the local vulnerable adults procedure and therefore would not be aware of her responsibilities in the event of a case of suspected abuse being reported to her when she was in charge of the home. This was required at the previous inspection. Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc Version 1.30 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 Hays House is well maintained and a programme is in place to improve a range of areas in the home environment. Equipment is provided to meet residents’ needs, this is regularly checked and serviced. Residents have recently potentially been put at risk by the lift tripping out, this is being addressed by the owner. EVIDENCE: All of Hays House appeared to be well maintained. The home have recently experienced problems with their lift, which was reported to the Health and Safety Executive. Records show that the lift has tripped out on 15 occasions in April, 10 in May and on 7 occasions in June prior to this inspection. The time of the trip out is documented but not the duration of the lift being out of action, this is needed to indicate how long the lift is out of action and to provide evidence to support Mrs Sheppard’s response that the lift is generally only out of order for a few moments and residents have therefore not been put at risk. The owner has written to the Commission confirming that he is seeking
Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc Version 1.30 Page 16 quotes for installation of a new lift and anticipates that a new lift will be installed during this financial year. A range of different communal rooms are provided and residents are also able to access the extensive gardens. Two of the residents were enjoying being pushed round the gardens by care assistants during the afternoon. The owner has been following a programme to improve bathing facilities and a new Parker bath has been installed on the second floor and works are underweigh to install a sluice room on the same floor. When these works are completed, an action plan is in place to improve disabled bathing facilities on the ground floor. As parts of Hays House are an older building, most of the rooms are different in character from each other, all rooms have extensive views of the surrounding countryside. The rooms in the newer section at the back of the house all have en-suite facilities, as do some of the rooms in the main building. All the bed bases have been replaced since the previous inspection. All fire exit doors have been provided with contact points which alarm if a confused resident decides to exit the building using these doors as they could be at risk from the external fire stairs and becoming lost in the grounds. One of the registered nurses said how effective the system had been in ensuring the safety of a particular resident with dual nursing care needs. Residents with complex nursing and care needs are provided with a range of equipment, including pressure relieving mattresses, variable height beds and hoists. All equipment is regularly serviced. Residents said that staff came quickly when they used their call bell, one resident said that staff had “come like a shot” recently when they had rung their bell because they had felt unwell in the night. Records of the temperatures of hot water outlets are regularly maintained. As identified at the previous inspection, some residents have requested supplementary heating for their rooms, a survey has been completed on this and supplementary heaters are on order, they are to be installed during the summer, this will mean that free-standing heaters will no longer be used in the home. Mrs Sheppard reported that the positioning of these supplementary heaters has been planned to ensure that they do not present a risk to residents. The laundry presented an organised appearance and the laundress was fully aware of her responsibilities. A new system for separation of different types of laundry has been introduced since the previous inspection and the home are awaiting delivery of two further trolleys for the home, to complete the introduction of the new system. The laundress reported that staff occasionally put laundry in the wrong bags when this happened, she felt able to discuss this with staff, to ensure that correct infection control procedures for management of laundry is in place. Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc Version 1.30 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, 29 A full range of staff with a skill mix to meet service users’ needs are in post. There are safe systems for the recruitment of staff to ensure that residents are protected. EVIDENCE: Hays House is required to staff the home in accordance with a Condition of Registration set out by the Commission. They were meeting the requirements of this Condition. There were two registered nurses on duty, in addition to Mrs Sheppard, during the inspection. Each floor of the home is managed by a senior care assistant, who reports to these two registered nurses, each of whom had responsibility for a different area of the home. Nursing and care staff are supported by a range of domestic, catering, laundry and maintenance staff. Mrs Sheppard reported that staffing of the home had recently improved and that agency staff were now very rarely used. The home has a system to ensure that all required pre-employment checks are carried out and this was supported by a review of staff files. Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.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, 32, 33, 36, 37 & 38 The manager of the home is an experienced manager and registered nurse. Residents and staff are supported by an open culture. Residents’ views on the home are regularly sought. Staff are supported by a well-established supervision system. All relevant records are maintained and systems to ensure health and safety are in place. EVIDENCE: Mrs Sheppard is an experienced registered nurse and manager. Staff reported that regular staff meetings take place, these are minuted. Relatives and staff were observed to pop in and out of Mrs Sheppard’s office, to consult her about a range of matters. Regular monthly audits take place, this includes records of residents’ comments on activities provided. Records show that staff receive regular supervision in areas relating to care provision. Two newly employed staff reported that they had received an induction programme and were aware of their responsibilities, however this was not documented on their file. Mrs
Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc Version 1.30 Page 19 Sheppard reported that as they were both experienced persons, they had not received the standard induction programme which was aimed at staff with less experience. Mrs Sheppard therefore cannot demonstrate that these staff had been indicted into all areas relating to the home, particularly fire safety procedures. A new documentary system has been introduced for residents’ valuables which have been handed in at the weekends. Regular checks on Health and Safety take place, this includes fire safety, equipment checks and manual handling. Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.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 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 3 3 3 x x 3 3 3 Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.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 7 Regulation 12(1)(a) 13(4)(c) 15(1) 12(1)(a) 13(4)(c) 15(1) Requirement Where a service user has a risk identified, a care plan must always be put in place to direct staff on how the risk is to be reduced. Where equipment is in use which is not in accordance with the service users assessed degree of risk, the clinical indicator(s) for this different equipment must always be documented. All assessments and care plans must be regularly reviewed. Timescale for action 30 November 2005 30 November 2005 2. 7 3. 4. 5. 7 9 18 15(2)(b) (c) 12(1)(a) 13(3) 13(6) Medicines adminstration records must always be fully completed at the time of administration. All staff who take charge of the 30 home in the manager’s absence, November must be trained in the local 2005 vulnerable adults procedure and be aware of their responsibilities for reporting to the POVA list. (This requirement was identified at the previous inspection, with a compliance date of 31 March 2005. It has not been addressed. A new date has been set at this inspection and action must be taken to address this requirement by the next
Version 1.30 Page 22 30 November 2005 31 July 2005 Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc inspection.) 6. 7. 19 21 23(2)(a) (b)(n) 23(2)(j) (k)(n) The Commission must be informed in writing of when the new lift is to be installed. The Commission must be informed of the timescale for completion of the homes action plan to improve sluicing and bathing facilities on the ground floor of the home. (This relates to parts of a requirement which was identified at the previous inspection, half of the requirement was addressed before the completion date of 30 June 2005.) 30 September 2005 30 September 2005 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. Refer to Standard 7 9 Good Practice Recommendations A system for the archiving of all care plans which are no longer current should be put in place. Where medicines administration instructions need to be written or changed by hand, they should be signed by the registered nurse completing the record and countersigned by a second member of staff. (This was identified at the previous inspection, it has not been addressed, but the manager is planning to put new systems in place which should make this recommendation easier to address). Where staff know of specfic service users needs in relation to certain drugs, these needs should always be documented. The record of the lift tripping out should include a record of the length of time the lift has tripped out. The induction for experienced staff should be in writing and a copy retained on their file. 3. 4. 5. 9 19 36 Hays House D51_D01_S15916_HAYSHOUSE_V228146_100605_Stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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