Inspection on 10/04/05 for Kent House

This inspection was carried out on 10th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Kent House 31/03/08

Kent House 19/06/07

Kent House 18/12/06

Kent House 11/05/06

Kent House 27/11/05

Kent House 28/06/05

Kent House 02/12/04

Kent House 22/06/04

Kent House 22/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Kent House George Street Okehampton Devon EX20 1HR Lead Inspector Helen Tworkowski Margaret Crowley Unannounced 10 April 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. Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Kent House Address Greorge Street Okehampton Devon EX20 1HR 01837 52568 01837 52580 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) Stonehaven (Healthcare) Ltd Vacant Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25), of places Physical disability over 65 years of age (25) Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18/3/05 Brief Description of the Service: Kent House is a large detached Victorian House located in the centre of Okehampton. The Home is registered for 25 older people who may have dementia, or a physical disability. There are 21 single bedrooms, nine with en suite facilities, and two double bedrooms. There is a shaft lift, although there are steps to 9 of the 21 bedrooms. These rooms are only suitable for service users who are able to negotiate steps to gain access to the rest of the Home. On the ground floor there are three lounges, a dining room, kitchen, two toilets, adapted bathroom, and 5 bedrooms. On the first floor there are 13 bedrooms and 2 bathrooms. On the second floor there are 5 bedrooms and 2 bathrooms. The Home has a front garden with seating and a small patio at the side of the home. Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced Inspection that took place on Sunday 10th April 05 between 8am and 5.30pm. An Unannounced Inspection on the 2nd December 04 raised serious concerns, which were followed up at a further visit on 18th March 05. A copy of the Inspection Summary Letter for this visit on 18th March 05 can be obtained from CSCI. The Inspectors looked at the majority of care records and all staff records during this Inspection. Time was spent with Service Users including eating two meals. The manager and one member of staff were spoken with during the visit. Time was spent speaking with four Service Users and two visitors. What the service does well: What has improved since the last inspection? What they could do better: There is no registered manager at Kent House, and the home is not well managed. Documents (Assessments, Service Users Plans and Risk Assessments) that provide information about how Service Users needs will be met either do not exist or are so lacking in detail that they are of little value. The lack of assessments before a person moves to the home mean that managers and staff do not know if they can meet the needs of that person. Service User Plans (or care plans) and risk assessments tell care staff what they need to do for each Service User and how to keep them safe. The lack of such information means that Care Staff have to make their own judgement about what is needed. Needs may be missed or met in different ways. This of serious concern, particularly where Service Users may not be able to explain to staff what their needs are because of dementia or illness. Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 Page 6 The quantity, quality, and variety of food and drink offered to Service Users is of concern. For example Service Users are only offered reconstituted powdered milk in their drinks and on cereals. If they do not like the main meal on the menu they can be provided with alternatives, these are the same every day of the week. The registered person has been required to offer a variety of wholesome food and drink. This must take into account people’s individual preferences, dietary needs, and care needs. The home has insufficient staff during the day and night; this means that Service Users needs are not always met. Previous agreements made by Stonehaven Ltd with CSCI have not been honoured. Staff do not always sit with people who need assistance to eat and drink. Staff are not always given training when they first come to the Kent House. There are no training plans in the home. The home has been required to provide sufficient staff who are properly trained to meet the needs of people who live at Kent House. Staff have not received regular training in relation to fire, for example on the day of this inspection 3 out of the 4 staff had received no fire instruction in the home. The fire log, which records the detail of when checks were made, has gone missing. All staff must receive regular and frequent fire instruction, other fire checks must be made and must be recorded. At the end of this inspection three immediate requirements were made. Four Enforcement notices have now been served. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 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 Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 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 and 4 Managers and staff are unaware of the needs of people who moved to the home and therefore do not have the information to decide if they have the ability to care for the individual before they move. This places the individual being admitted, other service users and the staff at risk. The Statement of Purpose and Service Users Guide are misleading with regard to the level of staff provided in the home. Prospective Service User may be misled about the level of service they may receive. EVIDENCE: The home has a format for assessing Service Users before they move to the home. The files of four service users who had recently moved to the home were examined during this visit. There was no record of any assessment for some individuals, whilst for others this assessment was totally inadequate. There was no record of the Registered Provider confirmed in writing that they are able to meet individual need prior to a move to the home. At the last two inspections requirements have been made that the Home must revise it’s Statement of Purpose and Service User’s Guide, to provide accurate information about the level of staff provided. These documents provide Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 Page 9 prospective Service Users with accurate information so that they can make an informed decision about moving to Kent House. Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 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. The system for recording Service User needs and how they will be met is inadequate. Service Users cannot be confident that staff will know what to do to meet their needs. At this inspection some Service Users’ needs were not being met by staff and they are being placed at unnecessary risk. Medication is not being properly administered and recorded, again placing Service Users at risk. EVIDENCE: There are “Service User Plans” for each person in the home. These documents should be drawn up from an assessment and should specify in detail the actions staff are to take to meet their needs. The level of detail in the plan should reflect the level and complexity of need of the individual. The Service User Plans seen at this inspection lacked detail and omitted essential aspects of information. Observations of Service Users during the period of inspection indicated that individual’s needs were not always being met. This was particularly obvious for drinks and food. One Service User required assistance to eat, but occasional Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 Page 11 encouragement was offered at breakfast. The result of this was that the individual ate a cold breakfast over an hour and half and apparently had nothing to drink between 8am and 12 noon. There were no risk assessments for Service Users who had moved to the home in recent months, and existing risk assessments had not been updated since the beginning of the year. No moving and handling assessments had been completed or updated since December 04. These documents provide key information about the assistance and equipment needed for Service Users to be able to move about safely. The Boots Monitored Dose System, (prepared by the pharmacist in bubble packs), is used at Kent House. The system was not fully inspected, however, concerns were identified. Medication was being crushed and placed in food to make the medication more palatable. There was no record of this or any discussions with the GP, Pharmacist and relatives. Also medication for constipation had been administered to an individual with diarrhoea, with no consideration of whether this was appropriate. A requirement was made at the last inspection that staff must receive training in relation to falls prevention. This requirement has not been met. Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 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 and 15 Kent House provides a poor diet to vulnerable people who may have very particular dietary needs and preferences. The dietary needs are not recorded or met. Insufficient support is offered to ensure that all Service Users have sufficient to drink. The dining facilities are not appropriate for people with dementia. Kent House offers limited activities and support, particularly for people with dementia. EVIDENCE: There is minimal information in the care home about individual dietary needs and preferences and no guidance as to how these needs will be met. Weight records are kept for a few people in the care home, but not necessarily for those who have weight issues. There was no monitoring of fluids intake, in spite of this being noted as an issue for some individuals. District Nurses have commented that they had on numerous occasions asked for fluids charts to be completed however staff have not done this. The home has a written menu, which is displayed on a board in the dining room. The home does not provide any cooked breakfasts, even on weekends. At breakfast the majority of Service Users ate cereals with re-constituted dried Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 Page 13 milk, and toast. All of the milk in the home is re-constituted dried milk, except that brought in by staff for their own use. The home uses only frozen vegetables and meat. Cakes and soups are made from dried mixes. There were some salad items and a bowl of fresh fruit. Whilst it is recognised that frozen foods may have a similar nutritional value to fresh food, Service Users should have the opportunity to eat food that they are familiar with and that reflects the food they have enjoyed throughout their lifetime. People with dementia or who have poor appetites must be offered a range of food that is not only healthy, but appeals to their tastes. Service Users who do not wish to eat the main meal are offered the option of pastie, pie, fish fingers, fish cakes, sausage-roll or veggie sausages, from the freezer. Records of food eaten show that one individual had had the same main meal for almost a week. The registered person has a responsibility to provide a varied and nutritious diet, even if that person is perceived as “finicky”. Staff were not available to offer other than passing assistance to Service Users with their breakfast even though they were not able to eat without support. Some of the plates and the place mats are patterned and a few of the people with dementia spent much of breakfast and lunch, distracted by these patterns. The people who needed help to drink were given their tea in worn plastic mugs. Staff said that this was because they might break proper ones. Service Users should be provided with appropriate crockery and if there is a risk of cups being knocked over, then support should be provided. No staff were with Service Users to help them to drink during breakfast. One hour after midmorning drinks, one person had her untouched drink still out of her eye line and reach. The radio in the dining room was tuned to Radio 1 through out breakfast and lunch. There was no evidence that Service Users enjoyed this music and it appeared to be nothing more than a needless distraction. Staff said that the quality of the coffee and milk in the home was very poor and they purchased their own rather than drinking that provided by Kent House. The cook has no food hygiene certificate or any training in relation to catering. Her experience of cooking was in cooking for her family. The people in Kent House have a range of dietary needs that needs to be catered for, the cook should be appropriately trained and competent. Previous requirements have been made that Service Users are given the opportunity for stimulation through leisure and recreational activity suited to the needs, preferences and capabilities. These should be clearly traced from the assessment. Assessments and Service User Plans contained sparse information about interests and hobbies and how they are to be met. Stonehaven (Healthcare) Ltd has forwarded to CSCI an activity plan, however this did not reflect individual needs. Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 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) These standards were not inspected at this unannounced inspection, however it was noted that at the previous inspection a requirement was made that the Registered Manager and senior staff attend the multi-agency adult protection training. This requirement has not been met. EVIDENCE: Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 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) 19,25 and 26 Kent House is clean and comfortable, however there are concerns over some aspects of safety in the home, which could pose a risk to Service Users. EVIDENCE: Kent House is reasonably well decorated, and was clean and tidy during this unannounced inspection. A full tour of the building did not take place, but the communal areas and a few of the bedrooms were seen and these were of a good standard. At the last visit to the home it was noted that one of the bedroom door locks had been “disabled” so it no longer worked. This was of concern to the person in that room. This door lock has now been reinstated, however this has not happened with other bedroom door locks. The home must provide appropriate bedroom door locks for all service users, unless the home can show that this would not be appropriate for that individual, a record of this must be kept. Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 Page 16 Discrepancies were noted in relation to the fire training and checks, this is recorded in other sections of this report. Requirements were made at the last inspection in relation to risk of scalds and from legionella, these have not been met. Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 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 and 30 New staff are not being properly inducted or trained to care for the people who live at Kent House. This places both Service Users and staff at risk, as staff may not fully understand their role. There are insufficient staff on duty in the home to meet the needs of Service Users. EVIDENCE: All of the care staff records were seen during this inspection. The most recent staff were non UK residents and had been recruited through a recruitment agency. The relevant checks had been completed with the exception of Criminal Records Bureau (CRB) checks. Records seen showed that written references and police checks had been carried out. However there was no evidence of any induction of new staff and there was little evidence of any training. CRB checks need to be completed for all new staff, including those who have recently entered the country from abroad. Until these checks of criminal records checks have been completed then new staff must be supervised at all times, they must have a named supervisor who must be on duty at the same time when ever possible. There were three care staff and a manager on duty on the day of the inspection. This level is reduced to three care staff from 5 pm to 8 pm and then 2 staff from 8pm to 8 am the next day. One of the staff sleeps between Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 Page 18 midnight and 6am, leaving one staff awake. Care staff are involved in cooking the evening meal and also clean at weekends. They also do all the laundry. There were insufficient staff to provide Service Users with assistance to eat their breakfasts. There was no record of any fire training in the home, and an immediate requirement was made for staff to have this training/instruction. As has already been noted the cook had not received any training in relation to food hygiene or cooking for elderly people. Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 32 Kent House is not well-managed and the lack of competent management is placing Service Users at unnecessary risk. EVIDENCE: The home has no registered manager in post, and the lack of proper management is reflected in poor practice identified in other areas of this report. The Responsible Individual, Mrs Dawn Stone, has visited the home as required by regulation, however has not noted any of the concerns raised during this inspection. The Responsible Individual has a duty to report each month to Stonehaven (Healthcare) Ltd on the running of the home. An application for Registered Manager must be made to CSCI. Requirements were made at previous inspection regarding sending copies of financial records to CSCI- this has not been met. The fire log, which contained information about when fire checks had been made, had gone missing. A new log has been started. Two bedroom doors Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 Page 20 were found to be wedged open, and an immediate requirement was made on this issue. Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 2 x 1 1 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 1 COMPLAINTS AND PROTECTION 3 x x x x x 1 3 STAFFING Standard No Score 27 1 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 1 1 x 1 x x x 1 Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP38 OP3 Regulation 23 14 Requirement Immediate Requirement: Fire Doors must not be wedged open. Immediate Requirement: Prospective Service Users must receive a comprehensive assessment of their needs which is recorded in writing. Immediate Requirement: All staff must staff must receive fire training and instruction. The statement of purpose and service user guide must be revised and provide an accurated account of accommodation and staffing. This was a requirement at the last two inspections and has not been met. Service Users must recieve a varied, appealing, wholesome and nutritions diet, which is sutied to the individual, assessed and recorded requirements. They must be provided with a more varied alternative choice of menu. This or similar requirement has been made at every inspection over the last three years. The responsible individual must confirm that design solutions are now in place to ensure that D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Timescale for action 10 April 05 10 April 05 3. 4. OP38,OP30 OP1 19 5 15 April 05 01 June 05 5. OP15, OP8 16 01 June 05 6. OP25 13 01 June 05 Kent House Version 1.20 Page 23 7. OP25 13 8. OP34 24 9. OP8 23 10. OP12 16 water is stored at a temperature of at least 60c and distributed at 50c to prevent risk from Legionella. This information must be sent to the Commission for Social Care Inspection. This requirment was made at previous inspections, timescale of 23/08/04 and 2/1/05 not met. Risk assessments indicate that 5 service users are at high or medium risk of scalds from hot water outlets that are not restricted to 43c. The wash-hand basins in their rooms and in communal facilities must have water temperature control devices fitted. This requirement was made was made at previous inspections, timescale of 23/10/04 and 2/2/05 not met. A statement of the business accounts and a business and financial plan must be sent to the Commission for Social Care Inspection. This requirement was made at the previous inspections and timescale of 23/08/04 and 2/2/05 not met. Staff must receive training in falls prevention. This requirement was made at the inspection on th2 2/12/05 to be met by 2/3/05. Service users must be given regular opportunities for stimulation through leisure and recreational activities suited to their needs, preferences and capacities. These should be clearly traced from the assessment to the service user’s care plan. This reqirement was made at the inspection on the 2/12/04 and has not been met by the time scale of the 2/1/05. D54-D07 S32744 Kent House V221059 100405 Stage 4.doc 1 June 05 01 May 05 1 June 05 1 June 05 Kent House Version 1.20 Page 24 11. OP7 15 12. OP18 23 13. OP27 18 14. OP29 19 15. OP9 13 The registered person must ensure that all Service User’s have up to date and comprehensive plans generated from a comprehensive assessment of their needs which is drawn up with each Service User (or their representative) and provides the basis for the care to be delivered. Service User’s Plans must set out in detail the actions which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the Service User are met. Service User Plans must be reviewed every month, or sooner if necessary, and updated to reflect changing needs. The registered manager and senior staff attend the multiagency adult protection training. This requriement was made at the inspection on 2/12/05 to be met by 2/4/05. The staffing ratio must be maintained at a level that meets the needs of service users at Kent House. This requriement was made at the inspection on 2/12/04 to be met by 3/12/04. The regisitered person must ensure that a Criminal records bureau / protection of vulnerable adults have been intitiated for all staff prior to starting work in the home. This includes staff from abroad. Whilst waiting for the check to be completed new staff must be underconstant supervision, must have a named supervisor who should be on duty at the same time whenever possible. The registered person must keep a record of any medication crushed and placed in food to D54-D07 S32744 Kent House V221059 100405 Stage 4.doc 1 June05 1 June 05 1 May 05 1 May 05 1 May 05 Kent House Version 1.20 Page 25 16. OP9 13 17. OP15 19 18. OP4 14 19. OP7 13 20. OP31, OP32 8,12 make it more palatable; and must keep a record of the discussion with the GP, pharmacist and the Service Users which permits this. All staff administering medication must be aware of the purpose of medication and seek advice when adminstration of medication appears not to be in the interests of the Service User Staff who prepare food must be trained in food hygiene and be competent and skilled in providing meals for elderly people. The home must confirm in writing to Service Users that it has the ability to meet the assessed needs prior to a move. The home must develop moving and handling and risk assessments for each service user. Kent House must be properly managed and an application made for the registered manager to CSCI. 1 June 05 1 June 05 10 April 1 June 05 1 May 05 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 OP33 Good Practice Recommendations The Home should produce an annual development plan. Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 Page 26 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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 Kent House D54-D07 S32744 Kent House V221059 100405 Stage 4.doc Version 1.20 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!