Inspection on 28/06/06 for Hillgrove

This inspection was carried out on 28th June 2006.

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

Hillgrove 13/03/06

Hillgrove 06/01/06

Hillgrove 09/02/05

Hillgrove 27/07/04

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

CARE HOMES FOR OLDER PEOPLE Hillgrove 79 Eleanor Road Bidston Wirral CH43 7QW Lead Inspector Leila Mavropoulou Unannounced Inspection 28th June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillgrove Address 79 Eleanor Road Bidston Wirral CH43 7QW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0151 652 1708 Mayflower Care Homes Ltd Mrs Kathleen Parker Care Home 23 Category(ies) of Dementia - over 65 years of age (23) registration, with number of places Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th March 2006 Brief Description of the Service: Hillgrove is a large detached property adapted for use as a care home, situated in a quiet residential area of Bidston, Wirral. The home is registered with the Commission for Social Care Inspection for the personal care and support of twenty-three older people who suffer from dementia and other organic psychoses. Accommodation is provided in both single and double rooms on three floors. Access to the upper floors is via a passenger lift. The home is equipped with appropriate aids such as grab rails, ramp, assisted bathrooms and a call alarm system. There is a car park at the front of the home and garden at the rear. Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which lasted six hours. During the inspection three service users, one visitor, three staff and the registered manager were spoken to find out their views about the service provided at Hillgrove. In addition, service users, staff records and other records were inspected. A tour of the building was carried out. What the service does well: What has improved since the last inspection? Since, the last inspection the registered provider and the registered manager have made significant efforts in meeting the requirements made in the previous inspection report. One bedroom carpet has been replaced, new care plan format have been implemented and medication procedures has been reviewed to promote the health and safety of service users. Risk assessment of the building has been carried out. Significant improvements in the recording and keeping of service users medication. Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5,6 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The staff assess new service users needs to ensure that their needs could be met before they are offered a place. EVIDENCE: Hillgrove’s Statement of Purpose provide prospective service users with information about the services and facilities offered at the home. The registered person should review the home’s Statement of Purpose to ensure it continues to reflect accurately the service provided. They should consider reviewing the format to make it easier for those reading it to have all the information without referring to other documents, which are less accessible. New service users are assessed by the manager before they are admitted to Hillgrove, to ensure service user needs could be met within the existing resources. Service users files show that information obtained from the preHillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 10 admission assessment is used to develop an initial service user plan and risk assessment. Wherever, possible service users are encouraged to visit the home before a decision is made to move to Hillgrove. Staff have the necessary skills and knowledge to meet the needs of service users as many have attended training specific to understanding mental health in older people as well as having completed the NVQ level 2 Care Award. However, improvements could be made through collective reflection by the staff group to develop strategies they have found successful in managing particular behaviour of service users, which should be incorporated in the service users plan, and kept under review. The home does not provide intermediate care. Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” Generally, the service users physical health needs are met. However, more emphasis is needed in meeting their mental wellbeing. EVIDENCE: The format of the service user plan is easy to understand. However, examination of a sample of service user plans showed that they do not reflect fully individual needs and preferences and does not demonstrate how the service user’s mental health needs would be met. The registered person must ensure that service users plans are reviewed to reflect changes in service user health needs following discharge from hospital as one service user had been discharged with a heart condition and this was not reflected in the service user plan. The plans must be more detailed and associated risk assessments developed to minimise risks to promote consistency and quality of care. Files seen showed that falls and waterlow risk assessment are completed to identify and minimise risks to service users. The falls monitoring form show a consistently high number of falls each month with some requiring hospital Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 12 treatment. The registered person must monitor the number of falls by service users more closely and take appropriate action by collating and evaluating information provided by staff, service user records, building risk assessment, accident book, the location of falls, layout of the building and the use of suitable aids to minimise risks. Service users daily records seen showed that service users receive regular check up from other health professionals as necessary. The District Nurse provides nursing care to service users such as: dressings, injections etc. The District Nurse intervention should be included in the service user plan. The recording of service user medication records has improved significantly since the last inspection. However, there were some inaccuracies of service user medication e.g. tablets not accounted for, medication signed as given on one occasion but tablet still in blister pack and another medication administered but not signed on service user medication chart as given. The service user plan should reflect whether they are compliant with taking their medication and where necessary advice should be sought from the GP. Controlled drugs were checked and found to be accurate. Handwritten entries on service users medication records were not countersigned by another member of staff. The registered person must ensure that an accurate record is maintained of all service users medication received into the care home, administered to service users and returned to the pharmacist. Service users medication record showed that the reason is documented when prescribed medication is given only when necessary. Observation of staff assisting service users with activities of daily living showed that service users right to privacy to dignity and respect are upheld. This was showed through the way in which staff spoke to service users, knocked on their bedroom door before entering and the way in which assistance was provided at mealtimes. Service user privacy is promoted through using privacy screens in shared bedrooms. Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The social needs of service users is met through regular visitors and the activities provided by the activities co-ordinator and staff. EVIDENCE: The activities co-ordinator has been appointed since the last inspection. Since, her appointment a wide range of group and individual activities have been provided to service users. These included an outing and some social events where family and friends were invited. Discussion with the activities coordinator indicated that she takes individual service users for short walk and has her mobile telephone, which she could use if she requires assistance in an emergency. Discussion with the activities person showed that activities provided to service users reflect their capabilities and preferences. Discussion with the registered provider indicated that specific training has been organised for the activities co-ordinator. Service users participation in activities is recorded in their individual activities records to demonstrate their social needs are being met. Observation during the inspection showed that one of the service user bedroom on the ground floor was used by the hairdresser for styling service users hair. The registered person must provide another area for this activity as it restricts the service user from using their bedroom and it is an intrusion on their personal space. Observation during the inspection showed that service users family take them out regularly. Visitors are welcome at Hillgrove throughout the day and service users choose where to see their Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 14 visitors. In the small lounge there is a pay telephone which service users could use to receive and make calls in private. Service users representatives manage their finances. The service maintains a record of all expenditure made on behalf of service users such as: hairdressing, chiropodist etc and the service user’s representative is invoiced monthly. On the day of the inspection, the cook was off and one of the care staff was preparing the meals. Observation of the teatime meal showed that presentation was poor and unappetising looking as no consideration was given to colour, texture etc. In addition no alternatives were readily available nor was there any evidence of choice being offered by staff to service users. The hot teapots were left on the trolley in the hallway unsupervised, which presented a high risk to the safety of service users given their mental capacity. The registered person must ensure that alternative meal is provided to service users and to review the way in which meals are served and presented. The service would cater for service users that require a special diet. A record is kept of food provided to service users. The registered person must ensure that additional staff is provided to meet the dietary needs of service users when the cook is off duty. Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Service users are protected from abuse through the home’s recruitment procedure and staff training. EVIDENCE: There has been no formal complaint since the last inspection. The complaint procedure is displayed in a prominent position, which gives details of how complaints would be investigated with timescale for completion of the investigation. Discussion with a service user family indicated that they had made a complaint informally regarding the loss of service user clothing. However, there was no documentation to evidence this and action taken to resolve the issue. It is recommended that the registered provider maintain a record of all informal complaint made by service users or their representative and details of how the complaint/concern was addressed. Discussion with staff indicated that service users would be supported to vote if they wish. Information on local advocacy services was available for service user and their representatives to use. Various policies and procedures are in place to protect the service users and staff from abuse. A copy of the Wirral Adult Protection procedure is available for staff to refer to. The registered manager has provided training to ten staff members on Protection of Vulnerable Adults. However, the registered person should plan further training to staff on Protection of Vulnerable Adults and Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 16 managing physical and verbal aggression to promote the safety of service users and staff. Staff refresher training on these courses should be encouraged. Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” There is ongoing maintenance and renewal at Hillgrove to improve the physical environment for service users. EVIDENCE: Generally, the home was clean throughout and on the day of the inspection. The home has a handyperson to carry out routine maintenance work to the building. A tour of the building showed the following: bedroom 16 window (outstanding from previous inspection), Room 11 new tiles need painting and bedroom carpet should be replaced as it is stained, small visitors lounge needs repainting, bedroom 13 wallpaper needs to be glued where it is coming away from the wall, and skirting board below radiator should be repainted. The area under the fire escape on the first floor needs sweeping and the ramp needs cleaning and ceiling paper in bedroom 18 needs re-glued. Bedroom 4 window Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 18 restrictors must be fixed and the woodwork surrounding the window replaced. Toilet on the ground floor near fire exit requires a lock to promote service user privacy. The home does not use CCTV cameras. The two communal lounges and a separate dining room on the ground floor could be used for a variety of activities and service users were seen to be freely accessing all of them. The registered person has sought advice from the Health and Safety officer to assess regarding the barrier used to prevent service users from going down the stairs. The number of toilets and assisted baths and walk in shower meet the needs of service users. These are situated close to service users bedrooms and the communal areas. The passenger lift enable service user to access their bedrooms on the upper floors easily and is serviced regularly as evidenced by maintenance records. Each service user bedroom has a call system. However, they are not used due to service users lack of capacity. Other aids such: grab rails, raised toilet seats etc are available to promote service users safety. Equipment used in the care home is serviced regularly to promote service users safety. Since the last inspection one bedroom carpet has been replaced. The home is centrally heated throughout and was checked in June 2006. All of the radiators have individual thermostats to enable service users to control the heating in their bedroom. The registered person must ensure that risk assessments for radiators are in place and service users bed are not placed near radiators. Radiator covers of guaranteed low temperature surface radiators should be installed. The bedrooms are bright and well ventilated. The laundry area is sited away from the food preparation area and policies and procedures are in place to minimise the spread of infection. A specialist contractor is used for the disposal of clinical waste. Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” The service promotes service users safety and ensures that staff have the basic skills and knowledge to carry out their roles and responsibilities. EVIDENCE: The staffing records and pre-inspection questionnaires showed that over 80 of the staff have completed the NVQ level 2 Care Award and that staff are inducted into their role in accordance with the National Training Organisation specification. Thus, core training in: food hygiene, load management (this is done in house by the registered manager as she is an assessor), fire awareness, and first aid is incorporated in staff NVQ level 2 Award. On the day of the inspection the staffing level was inadequate to meet the needs of service users as the cook was not on duty and one of the care staff was preparing the meal. In addition, the registered manager was off the premises, leaving only two care staff to meet the needs of service users. The registered person must ensure that staffing levels are maintained at all times at the care home to promote service users safety. Discussion with staff indicated the dependency level of service user has increased. The registered person must review the staffing level to reflect the dependency level of service users and the number of service users falls. Domestic and catering staff are employed in sufficient numbers to maintain the cleanliness of the building and dietary needs of service users. The registered Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 20 person must ensure that on the cook’s day off another member of staff is available for preparing service user meals. Examination of a sample of staff files showed that two written references, a Criminal Record Bureau/POVA check was obtained, staff were given a written terms and conditions and identification. Discussion with the registered manager indicated that job descriptions are given to staff. However, a copy of the staff job description should be kept on their file. Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,35,36,37,38 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” The management of the service could be more pro-active in delivering a service targeted to meeting the needs of the service user group. EVIDENCE: The registered provider has informed the Commission that the registered manager has given her notice to resign from her post. Interim arrangement has been made for the management of the service until a manager is appointed. There is a quality assurance system in place to obtain service user views and other stakeholders about the quality of the service. However, the registered provider should consider placing more emphasis on the category of the home’s registration to demonstrate that the service is focused and is actively working to providing services and facilities to reflect the mental health needs of service users. Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 22 Staff and management are held monthly and minutes of the meetings are kept. Individual staff supervision has been implemented and a record is kept of issues discussed as evidenced in staff files seen. A current Public Liability Insurance certificate was displayed. The service users records are kept in a secure place in accordance with the Data Protection Act. The record keeping at the care home has improved to promote service users safety and health. However, accurate recording was not found in some service users medication records and the service user plans did not accurately reflect the needs of service users mental and physical needs. The service promotes the health and safety of service users by carrying out regular routine fire checks, maintenance of equipment used and that of the building as evidenced in records seen and the pre-inspection questionnaire. Records of incidents/accidents are recorded and where necessary the Commission is notified. The last fire evacuation was 31st May 2006 and a record was kept of staff present. Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 3 2 3 Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13(4)(b,c) Requirement The registered person must ensure that service users plans and risks assessments are detailed giving clear guidance to staff on how the service user assessed needs would be met and minimise identified risks. The registered person must ensure that the service user care plan show compliance with medication and how their mental health needs would be met and monitored. Where service user’s care is provided by others e.g. District Nurse this should be identified in the service user plan. Timescale for action 28/08/06 2 OP8 13 3. OP9 13(2) The registered person must 28/08/06 review service users falls risk assessments and ensure that suitable measures are in place to minimise risks of falls to service users such as: staffing level, use of additional aids etc. The registered person must 28/08/06 ensure that an accurate record is maintained of all service users medication received into the care DS0000040990.V305063.R01.S.doc Version 5.2 Page 25 Hillgrove home, its administration and medication returned to the pharmacist. Service user’s medication record must sign when medication is administered or symbol used to show it has been refused. 4. OP19 23(2)(d) 28/08/06 The registered person must ensure that a programme of maintenance and refurbishment is produced and implemented. bedroom 16 window (outstanding from previous inspection), Room 11 new tiles need painting and bedroom carpet should be replaced as it is stained, small visitors lounge needs repainting, bedroom 13 wallpaper needs to be glued where it is coming away from the wall, and skirting board below radiator should be repainted. The area under the fire escape on the first floor needs sweeping and the ramp needs cleaning and ceiling paper in bedroom 18 needs attention. Bedroom 4 window restrictors must be fixed and the woodwork surrounding the window replaced. Toilet on the ground floor near fire exit requires a lock to promote service user privacy. 28/08/06 5 OP25 6 OP27 13(4)(a)(c The registered person must ) ensure that all parts of the home to which residents’ have access are free from hazards and unnecessary risks are as far as possible eliminated, by ensuring that all radiators have radiator covers or have guaranteed low temperature surface. 18 The registered person must ensure that at the times the home is suitably staffed to meet the assessed needs of service DS0000040990.V305063.R01.S.doc 28/08/06 Hillgrove Version 5.2 Page 26 7 OP8 13 users, as on the day of the inspection one of the care staff was carrying out catering tasks. The registered person must ensure that a falls risk assessment is completed and reviewed regularly where falls have been identified in the service user plan. 28/08/06 9 OP15 13 10. OP18 13 & 18 The registered person must 28/08/06 ensure that during mealtimes hot dishes and teapots are not accessible to service users to promote their safety. The registered person must 28/08/06 ensure that staff receive training on managing and physical and verbal aggression to promote the safety of service users and themselves. Where staff have already received training in managing physical and verbal aggression refresher training should be provided to ensure that the staff knowledge and skills continue to be current. This is outstanding from the previous report. The registered person must ensure that all parts of the building internally and externally are of sound construction and repair. The registered person must ensure that the following repairs are carried out: The registered person must ensure that at the times the home is suitably staffed to meet the assessed needs of service users, as on the day of the inspection one of the care staff was carrying out catering tasks, which prevented her from providing care to service users. The registered person must ensure that accurate records are DS0000040990.V305063.R01.S.doc 11 OP24 23 28/08/06 12 OP27 18 28/08/06 13 Hillgrove OP37 17 28/08/06 Page 27 Version 5.2 kept of treatment and care provided to service users at the care home i.e. service user plans reflect care provided and medication records. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The registered person should review the home’s Statement of Purpose to ensure that prospective service users or their representative have all of the information in one document and do not have to refer to other documents to understand the home’s policy and procedures. The registered person should ensure that handwritten entries on service user’s medication record is countersigned to comply with the guidelines of the National Pharmaceutical Society. The registered person should ensure that alternative meals are offered to service users in a format, which they can understand, or through staff explaining to service users. The registered person should review the overall presentation/appearance of service user meals to ensure they are appetising to maintain service user’s appetite. The registered person should maintain a record of concerns raised by service users or their family/representatives. 2 OP9 3 OP15 4 OP16 Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Hillgrove DS0000040990.V305063.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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