Inspection on 12/01/06 for Hulton Care Home

This inspection was carried out on 12th January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hulton Care Home 07/06/07

Hulton Care Home 16/08/06

Hulton Care Home 04/08/05

Hulton Care Home 01/02/05

Hulton Care Home 16/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Hulton Care Home Hulton Drive Off Halifax Road Nelson Lancashire BB9 0EY Lead Inspector Mrs Pat White Unannounced Inspection 12th January 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 Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 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. Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hulton Care Home Address Hulton Drive Off Halifax Road Nelson Lancashire BB9 0EY 01282 617773 01282 614445 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) Southern Cross Care Homes Limited Care Home 30 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (5), Old age, not falling within any other of places category (22), Physical disability (1) Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Within the overall registration of 30, a maximum of 22 service users requiring personal care who fall into the category OP shall be accommodated. Within the overall registration of 30, a maximum of one service user who falls into the category PD shall be accommodated. Within the overall total of 30, a maximum of 5 service users (over 65 years) requring personal care who fall into the category of DE(E) Within the overall total of 30, a maximum of 2 service users (under 65 years) requiring personal care who falls into the category of DE The registered provider, shall at all times, employ a suitably qualified manager who is registered with the Commission for Social Care Inspection. 4th August 2005 Date of last inspection Brief Description of the Service: Hulton Care Centre is a purpose built care home situated in a residential area on the outskirts of Nelson. It is owned by a national organisation called Southern Cross. The grounds to the front of the home are pleasant and accessible. Extensive lawned areas surround the home and there is adequate car parking space. The home is able to accommodate up to thirty people, both men and women. Twenty-two places are available for older persons who require personal care and one is for a physically disabled service user who is under 65 years. There is a seven-bed unit, for service users over 65 years who have dementia. All the bedrooms in the home are single rooms, and include en-suite toilet and hand basin. Many of the bedrooms were personalised with small items belonging to the residents and they are bright and comfortable. There are a number of lounges, including a smoking lounge, and dining areas. These communal areas are pleasant and homely. The home was decorated and furnished to a high standard. An activities organiser was employed in the home and there was a programme of interesting and lively activities. A manager and deputy manager were responsible for the day – to - day running of the home. Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection, and as such the residents and staff in the home did not have time to prepare. The purpose of the inspection was to assess important areas of life in the home that should be inspected over a 12 month period, check the progress of previous legal requirements and good practice recommendations, and check other matters in the home which came to the inspector’s notice. The inspection took 8 hours and comprised of, talking to residents, a tour of the premises, looking at residents’ care records and other documents, and discussion with the manager, Mrs Donna Laird. Seven residents were spoken with about the home, and others were met and observed in their routine daily activities. One relative was also spoken with. Comment cards were left in the home for residents and relatives to complete and return to the CSCI. At the time of writing the report 12 comment cards from residents had been returned. The significant views expressed by all the people involved have been summarised in the report. What the service does well: The records of resident’s needs were well written, and covered all the important matters regarding health and personal care needs. Members of staff were praised for their kindness, commitment and patience. Residents said they were well looked after. One resident said “all the staff were very nice”. Another resident said that “staff do the best they can”. All residents who took part in the inspection stated that staff treated them properly – with respect and dignity. The written plans for residents’ care were detailed and well written, and contained useful information regarding the residents’ health, personal and social care needs. These plans for care were regularly reviewed and updated. There were good links between the “risks” identified, for example the risk of pressure sores, and the action taken by carers to reduce the risks. The residents’ health was monitored carefully and appropriate action taken. Routines were flexible enough to suit individual preferences. Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 6 The home employed an activities organiser, and there was a wide programme of interesting and enjoyable activities, including regular trips out. Hulton Care Home provided modern, pleasant, bright and well - maintained accommodation throughout, which was decorated and furnished to a high standard. Residents said they appreciated their bedrooms and the outside areas. A high proportion of the staff in the home had gained the qualifications recommended for people working in care homes. What has improved since the last inspection? What they could do better: The written information about people living in the dementia unit could be improved to include useful information about behaviour and psychological matters. The way medication is managed and given to residents must be improved with priority to ensure the safety and well being of the residents, and number of legal requirements must be met immediately. Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 7 The home must make sure that there are enough staff on duty at all times so that the needs of the residents can be met. The way the home recruits staff should be improved to ensure the employment of suitable staff. 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. Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 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 Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 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, 2, 3, 4 & 5. Standard 6 was not applicable Useful information about the home was given to all residents but this needs to be made more specific to Hulton Care Home. The home’s admission procedures, including pre admission assessments and prior visits by prospective residents and relatives to the home, helped to determine whether or not the home could meet people’s needs. Not all residents were confident that there were always enough staff to meet their needs. EVIDENCE: As corporate documents of Southern Cross the Statement of Purpose and the Service User Guide met the Care Home’s Regulations and National Minimum Standards for Older People. However these documents were not fully reflective of the specific service provided at Hulton Care, for example there were references to the “Determining Nurse” and the “Nurse on Duty” and no reference that the older people with dementia are looked after in a specific unit. Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 10 The manager stated that those residents on respite care and residents who were privately funded did not have the home’s terms and conditions. This is outstanding from the last inspection. There was evidence from the records viewed, and from an admission on the day of the inspection, that an assessment of needs was undertaken with prospective residents before admission to determine whether or not the home could meet her needs. Social work assessments that had been carried out were also obtained. The in - house assessment included all the matters listed in the standard. Since the previous inspection there had been no one admitted into the dementia unit, but residents must not be admitted to this unit without a pre admission assessment and medical diagnosis that support a placement in a specialist dementia unit. It is strongly recommended that all references to “nurse” in the documentation be changed to a term(s) more appropriate for a residential care home. All those residents who were spoken with, and who were able to give their views, stated staff were kind and caring. One resident stated that “they did their best” and one resident felt there were not enough staff on duty. Three residents who completed comment cards said that they were only “sometimes” treated well. One person who completed a comment card stated that “an extra member of staff was sometimes needed”. One resident spoken with confirmed that she had visited the home prior to deciding to come and live there and had also visited other homes. Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 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 The care plans were detailed and well written and contained useful information about all aspects of residents’ health, personal and social care needs, to assist the care staff in providing care to residents. This could be improved in the dementia unit with respect to specific mental health and behaviour matters. The residents’ health care needs were promoted and maintained, but medication management in the home must be improved with priority to safeguard residents’ health. EVIDENCE: The records viewed showed that residents had care plans generated from an assessment. The documentation enabled comprehensive information to be recorded and the care plans contained detailed useful information to help staff to meet the residents’ needs. Appropriate risk assessments were in place, including those for risk of falling, risk of pressure sores, moving and handling and nutrition. Care plans had been reviewed and updated regularly. There was evidence that residents and relatives were involved in the compiling of the care plans. On the day of the inspection the husband of the person admitted was assisting in the completion of his wife’s care plan. Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 12 There was evidence that the residents’ health was monitored and maintained and residents had access to all the health care services. Most health matters were recorded in detail on the care plans, including pressure areas and continence issues. There were nutritional assessments. However mental health and psychological issues need to be documented in more detail and addressed according to clinical guidelines, especially in the dementia unit. There were good links between the risk assessments, the measures identified to reduce the risks and the details on the care plans, for example pressure areas. There was appropriate intervention and treatments by the district nurses, including that for pressure areas, and there was evidence of intervention by the specialist continence advisor. With respect to the way residents’ medication was managed and administered, some legal requirements made form the last inspection had been met. However some serious errors were found at this inspection and these must be addressed as a matter of priority in order to safeguard residents’ health. In particular Warfarin had been administered incorrectly and instructions from the clinic not followed. An “Immediate Requirement Notice” was issued to investigate and rectify this. There were numerous other errors, such as some medication had been booked in incorrectly, so that it was unclear whether or not the medication was discontinued, and the MAR sheets viewed contained confusing and incorrect information. In addition there were gaps in the recording of administration of medication and some records of administration had been made incorrectly. There were examples of medication signed as given but which had not been, and one resident was being given an incorrect dose of a medication because the handwritten instructions on the MAR sheet were different to that on the label. Another MAR sheet showed that discontinued medication was being signed as being given. Printed medication on some of the MAR sheets did not correspond to that being given. A number of legal requirements have been made which must be complied with. Policies and procedures were unchanged from the previous inspection and need developing according to the Royal Pharmaceutical Guidelines. Though standard 10 was not fully assessed, all those residents who completed comment cards and those who were spoken with stated that their privacy was respected Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 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, 14 & 15 Routines were flexible enough to suit individual preferences. Enjoyable and interesting activities and outings were frequently arranged which benefited the residents. The food served was appetising, wholesome, enjoyed by most residents and afforded them choices. EVIDENCE: Routines in the home were flexible to meet residents’ individual expectations and preferences. For example residents confirmed that they could rise and retire at a time of their own choosing, and could eat in their bedrooms if they wished. Church ministers of different denominations visited the home. The home employed an activities organiser and residents confirmed that a variety of enjoyable and interesting activities were arranged, including trips out. All residents who completed comment cards stated that the home provided suitable activities. Residents stated that they had enjoyed the Christmas festivities. Choices available to residents were stated in the Statement of Purpose, and include those mentioned above and choices of meals. Residents were able to bring small items of furniture and other personal possessions with them. However 4 residents who completed comment cards stated that they wished Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 14 they had more choice in the running of the home. handling their own financial affairs. Non of the residents were The food served at lunch - time at the time of the inspection appeared appetising and wholesome. Most residents ate in the attractive dining room and carers were available to assist those who needed it. Those residents spoken with stated that they had enjoyed the mid – day meal and that in general the food served was very good. Eight residents who completed comment cards stated that they enjoyed the food, 4 stated that they” sometimes” did. However it would be helpful to the residents if the meal written on the menu board in the dining room was the same as that served. Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 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): None The standards in this section were not assessed EVIDENCE: Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 16 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 In this section only the requirements made at the previous inspection were checked and they were both complied with. The home provided a safe, clean pleasant and comfortable environment for the residents. EVIDENCE: Only a partial tour of the premises was carried out at this inspection and the requirements made at the previous inspection were checked. The hot water temperatures at sink outlets were being monitored and showed that residents were not at risk from water that was too hot. All parts of the home viewed were clean and fresh and the odour in the bedroom identified at the last inspection was improved. The premises were modern, purpose built and therefore suitable for their stated purpose. They were well maintained, furbished and decorated. The 7bed unit for people with dementia was self contained and comprised part of the ground floor. It was also attractively furbished and decorated with sensory Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 17 plaques on the walls. A lift provided access between the ground floor and the first floor. A maintenance person was in post. The grounds appeared well maintained and provided a pleasant area for residents to sit and walk. One bathroom with an assisted bath was still out of order due to problems with the floor. This had been the case since the previous inspection. Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 18 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, 29 & 30 Though staffing levels appeared to be at the minimum required by the previous registration authority, there was evidence that this was insufficient for meeting the needs of all the residents at certain times. The home’s staff recruitment policies and procedures could be improved to protect the residents from unsuitable staff. The home’s staff training programme was being developed to meet the needs of the residents and the staff group. EVIDENCE: On the day of the inspection the home was staffed according to the minimum levels recommended by the previous registration authority. However there was evidence that sharing staff between the two units at times caused staff shortages. Some residents commented that they had to wait an uncomfortable length of time for assistance. However staff were praised by all who were spoken with for their attitude, kindness and commitment to the job. One resident stated that the “staff were very nice” and another said the staff “do the best they can”. With regard to staff recruitment, for one member of staff records showed that she had commenced work before the CRB/POVA check had been returned and that there was only one reference for this person. The most recently appointed care assistant had only one written reference from an employer; the other was from a friend. Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 19 Staff had undertaken a variety of short training courses, in addition to NVQ courses, and according to their own needs and those of the residents. Most staff working in the dementia unit had undertaken a short course on caring for people with dementia, but those moving from the old persons’ unit to assist in the dementia unit had not. The home’s induction training programme had been developed in accordance with the “Skills For Care” specifications. Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 20 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 The manager had been in post for about 6 months and was studying for the relevant qualifications. She was undergoing registration with the CSCI. There were suitable quality monitoring procedures and the residents were consulted about their views on the home. EVIDENCE: The manager Mrs Donna Laird had been in post for about 6 months. She had a number of years experience working in the care sector and had worked her way to the position of manager through senior carer and deputy manager positions. Mrs Laird had some relevant qualifications and was studying for the Registered Managers Award. She expects to complete this course in April 2006. Mrs Laird had applied to the CSCI for registration. The operations manager in the organisation supports Mrs Laird and regularly visits the home. Care staff had one to one supervision sessions with the manager. Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 21 The home had appropriate quality monitoring systems and a residents’ survey had been carried out in October 2005. The results of this were posted on the home’s notice board and supplied to the CSCI. This report indicated several areas which residents felt could be improved, such as odours in certain areas of the home, choice of meals and the bathing routine. The report indicated how these would be addressed. There were regular residents’ meetings and residents were given access to the inspector. Only the previous requirement in relation to “Safe Working Practices”, and regarding fire precautions, was checked. It was established that fire drills were held appropriately every 6 months and that the fire alarm was tested weekly. Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 22 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 2 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x 3 X X 2 X X X x STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X X X x Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4&5 Requirement The Statement of Purpose and the Service User Guide must be made specific to Hulton Care Home, and must remove references to nurses working in the home and also explain that the residents with dementia are accommodated in a specific unit. Timescale for action 31/03/06 2. OP2 5(1)(b) &(c) 3. OP7 15 4 OP9 13(2) Those residents having respite 31/01/06 care, and those who are privately funded, must be issued with appropriate terms and conditions / contract. The registered person must 11/02/06 ensure that the service users plan sets out in detail all the action to be taken to ensure all aspects of health needs, including mental health issues, are met. (Previous 2 timescales not met) The medication policies and 11/03/06 procedures need to be developed further to include, home/leave visits, homely remedies, oxygen, PRN medication, verbal changes and non - prescribed medication. DS0000022503.V276024.R01.S.doc Version 5.1 Page 24 Hulton Care Home 5. OP9 13 (2) 6. 7. OP9 OP9 13(2) 17(1a)S3 (i) 13(2) 8. OP9 13(2) 9. OP9 13(2) 10. OP9 13(2) 11. OP9 13(2) 12. OP9 13(2) 13. 14 OP9 OP9 13 (2) 13 (2) (Previous 2 timescale not met) The manager must undertake an investigation into the incorrect administration of Warfarin and ensure that correct safe procedures are followed. She must confirm the action taken to the CSCI by 20/01/06 All medication administered must be recorded on the MAR sheets. (Previous timescale not met) All medication must be booked in correctly when received into the home and accurate instructions written on the MAR sheets. The manager must ensure that the instructions and information on the MAR sheet is correct, including that relating to discontinued medication. All hand written information on the MAR sheets (transcribing) must be checked and witnessed to prevent errors. The registered person must ensure that the MAR sheets have identical instructions to the medication labels and that the correct medication/dosages are given (Previous timescale not met) The criteria for the administration of PRN medication must be clearly defined and recorded (Previous timescale not met) All prescribed medication must be given unless there is a justified reason which is explained on the MAR sheet. With variable dose medication, the doses given must be specified on the MAR sheet. If medication is not given it must not be signed as given on the MAR sheets but the reason for omission specified. DS0000022503.V276024.R01.S.doc 20/01/06 12/01/06 12/01/06 27/01/06 12/01/06 12/01/06 27/01/06 12/01/06 12/01/06 12/01/06 Hulton Care Home Version 5.1 Page 25 15 OP9 13 (2) 16 OP9 13 (2) 17 18 19. OP9 OP21 OP27 13 (2) 23(2)(b)& (c) 18(1a) 20. OP29 19 Sch 2 21. OP30 18 The correct opening day of eye drops must be recorded and they must not be used after the date stated. When residents are admitted the medication must be verified with the medical practitioner so that the correct instructions can be transferred to the MAR sheets and the correct medication given PRN medication, and the dose, must be recorded on the MAR sheet when given. The bathroom identified must be restored to be safe and operational The registered person is required to review the staffing levels within the home and ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person must ensure that staff do not commence work until the CRB/POVA checks have been returned and that two written references from previous employers are obtained The registered person must ensure that all members of staff who work in the dementia unit undertake appropriate training. 12/01/06 12/01/06 12/01/06 31/03/06 31/01/06 12/01/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000022503.V276024.R01.S.doc Version 5.1 Page 26 Hulton Care Home 1. 2. 3. Standard OP3 OP9 OP31 It is strongly recommended that all references to nurse in the documentation be changed to a term(s) more appropriate for a residential care home. It is recommended that a supply of eye drops is prescribed and used for each eye to prevent cross infection. The registered manager should complete the appropriate NVQ level 4 courses by the projected date Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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 Hulton Care Home DS0000022503.V276024.R01.S.doc Version 5.1 Page 28 - 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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