Inspection on 17/05/06 for Kingfisher House

This inspection was carried out on 17th May 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

Kingfisher House 12/01/10

Kingfisher House 22/05/07

Kingfisher House 25/11/05

Kingfisher House 02/08/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Kingfisher House 171 Yardley Green Road Bordesley Green Birmingham West Midlands B9 5PU Lead Inspector Jane Walton Unannounced Inspection 17th May 2006 08.50a 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 Kingfisher House DS0000063702.V290174.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. Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Kingfisher House Address 171 Yardley Green Road Bordesley Green Birmingham West Midlands B9 5PU 0121 753 0333 0121 771 4190 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) home.fxg@mha.org.uk Methodist Homes for the Aged Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38), Terminally ill over 65 years of age (38) of places Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That the Home can accommodate 38 service users who are older people (over 65 years of age) and people over 60 years of age with a terminal illness. That the home can accommodate two named service users under 65 years of age who have physical difficulties. 25th November 2005. Date of last inspection Brief Description of the Service: Kingfisher House Nursing home is a purpose built, single storey home and provides nursing care for up to 38 older people. It is situated in a residential area within the boundary of Heartlands Hospital. It is close to shops and local amenities and is accessible to public transport. The home is warm and homely and furnished to a high standard. It is very well maintained, with pleasant well maintained private gardens to the rear of the property. There are adequate parking facilities at the front of the building. Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this inspection over a full day (10 hours) in May 2006. It was an Unannounced Key Inspection. There were 33 residents in the home at the time, and the inspectors were able to talk with 13 of them. Information was also gathered from talking with 3 relatives, formal interviews with 3 staff, and informal chats with a further 4 staff plus the acting manager. A sample of records were examined, and a tour of the premises was undertaken. What the service does well: What has improved since the last inspection? This inspection demonstrated that a lot of effort has been made by the new manager and all the staff of the home to improve the standards within the home since the last inspection. The pre admission process is now more robust, and the manager ensures that the needs of an individual can be met by the home before they are admitted. The standard of the care plans has improved, and are easier to follow. There is now an improved system for managing concerns and complaints, and evidence Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 Page 6 indicated that staff are familiar with the homes Adult protection policy and procedures. The general standards of cleanliness in the home have improved, and extra housekeeping staff have been employed, together with some new equipment. An extra trained member of staff is now on duty during the day, and a programme of training in Palliative Care has been delivered to all staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 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 the following standard(s): 1, 3, 5 All the practices and procedures surrounding the admission of new residents were adequate and appropriate to ensure that the home is able to fully meet their needs. Prospective residents are provided with sufficient information to enable them to make an informed choice about living in the home. EVIDENCE: There is a Statement of Purpose and Service Users Guide that has been produced by Methodist Homes and has been personalised to the service that Kingfisher House provides. Copies are available for prospective residents and their families. The pre admission process has improved since the last inspection, and evidence was seen that a comprehensive assessment of the individual prospective resident is carried out prior to admission, to ensure that their needs can be fully met by the service that the home currently provides. Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 Page 9 The relatives of a prospective resident were visiting the home on the day of the inspection, and stated that they had been welcomed by staff and shown around the home, despite turning up without a prior appointment. They stated that they found the staff helpful and were offered plenty of information about the home. Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9, 10 The arrangements for care planning and monitoring physical and emotional health had improved, but a greater attention to detail will ensure that all their needs are met. The medicine administration in the home is of an adequate standard, robust auditing will prevent potentially poor outcomes for some residents. Residents are treated with respect and their right to privacy is upheld. EVIDENCE: A sample of residents’ care plans were examined. The standard was seen to have improved since the last inspection, and it was evident that much work has been done to achieve this. Needs had been identified and in all cases the management required was explained, although greater detail is needed. A range of risk assessments had been carried out including moving and handling, pressure sore risk and nutrition. Monitoring charts for weight, nutritional intake and healing progress of wounds were present. Evidence was seen that residents have access to GP’s and other health professionals as required including a physiotherapist, optician and dentist. The activities enjoyed by one of the residents were listed in the care plan however; there was no record in the daily records as to whether any of these had been undertaken by them. Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 Page 11 One resident had a bed rail assessment but it was not clear whether the risk identified was greater with them or without them, nor was there any history recorded of falling out of bed. In the same care plan, the resident had been identified as requiring 3 hourly turns, but there was no “skin marking” assessment to support this time scale, and in another section of the plan, it was stated that 2 hourly turns were required. There still needs to be more specific information given regarding such things as the size of slings to be used when hoisting, and greater consistency of information within the plan is required. An audit of the medication management within the home was carried out. The overall medicine management in the home is of an adequate standard. A Monitored Dosage System (MDS) is used within the home although some boxed medicines are also kept. There is a separate fridge for the storage of medicines requiring refrigeration, and the temperature is recorded on a daily basis. This was found to be too high, and should be maintained below 8 degrees centigrade. There is cupboard for the storage of controlled drugs (CD’s) that complies with regulations, and the three drug trolleys are secured to the wall when not in use. The CD register was examined and there were entries dating back to last year where there was no indication that drugs that should have been returned to the pharmacy or destroyed, had been. Since the new acting manager has been in post a new safeguard system has been introduced to ensure that this does not happen. All the counts for current CD’s were correct. There were photos of the residents and copies of the prescriptions are kept for cross-referencing purposes. All MDS counts were correct. There was a signature missing on one of the Medicine Administration Record (MAR) charts examined, and on two charts, it had not been indicated whether 1 or 2 tablets of an analgesic had been administered, so it wasn’t possible to determine a correct count. One boxed medicine count was inaccurate and a record of a residents pulse rate was not always recorded prior to administering Digoxin. There did not appear to be any issues regarding privacy and respect accorded to the residents. One resident stated that she found the staff kind and caring. Another said that she preferred to go to bed at 9.30pm, but it depended who was on duty, as to whether she was “put to bed” or went when she wanted to. One resident stated that sometimes, “when she feels like it, she has her breakfast in bed, and the staff all know exactly how she likes her toast, and that she prefers coffee to tea”. All residents were well presented, and their personal clothing was clean and well cared for. Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14, 15 Where possible the residents are encouraged to exercise choice. The quality of the meals is varied, although the selection of food available helps to promote the residents well-being. The activities provided for residents generally matches their expectations and preferences, thus contributing to their quality of life and independence. EVIDENCE: There was a list of activities on display in the house groups, and residents confirmed that activities took place. One said that entertainers came to the home and at the time of the inspection, an outside person was taking some of the residents through movement to music in one of the house groups. Another resident said that she has relatives who visit regularly and take her into Birmingham for shopping and lunch. A wheelchair taxi is organised by the home. In one of the care plans that were examined the residents activity preferences were given, however, there were no entries in the daily records to indicate whether any of them had been undertaken. Several residents said that they enjoyed watching television and reading, books and a newspaper. Aromatherapy is offered to residents. One lady had had her nails recently manicured and polish applied, which she said was “great, as it’s been ages since it was done. Makes me feel good.” The manager informed the inspectors that a beauty therapist had just been hired and was due to start in 2 weeks time. Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 Page 13 Several visitors were in the home, and spoke to the inspectors. Feedback given was generally positive, with one saying that staff were always very friendly and welcoming. One visitor said that things were “better with the new manager, and you often saw him around the home.” One resident visits the day centre every week where they are able to meet with different people. The bedrooms that were seen all had personal items including pictures and some small items of furniture. Efforts had been made to enhance the homeliness of bedrooms. The inspectors joined residents in 2 of the house groups for lunch. In one of the groups the meal was served at 12.40pm, and there was a choice of cottage pie, sausage casserole or broccoli and cheese bake, served with potatoes and mixed vegetables. Residents are asked to make their choice the day before, but if on the day they do not want it, an alternative is offered. Salads are also available. The residents appeared to enjoy their meals and no one was rushed to finish. When asked, one resident said they liked the food, and another, that it had improved. One resident said that a while ago they had had “cause to complain about the food, and it had improved for a while, but was still variable in the quality.” A dessert of chocolate sponge and custard or fresh fruit, grapes and bananas was served. Some residents had a cup of tea with their meal; others had a glass of squash. A resident who was PEG fed did not join the others in the dining room. The dining area was nicely presented, with linen cloths and napkins on the tables, together with a small vase of flowers. At the beginning of the meal there was a radio playing loudly, and one of the care staff turned it down, as it was very distracting for the residents. Several of the residents sat in wheelchairs at the tables, all being fitted with footplates. The wheelchairs do not always offer the best seating position from which to comfortably reach the table and eat the meal. An instance of poor practice was seen when a carer offered one resident assistance with drinking a milky drink. This was discussed with the manager who immediately dealt with the matter. In one of the other dining areas, the inspector sat with the residents for half an hour before their meals were served, by which time, food was not very hot. The residents said that generally the meals were good, although could vary, and one resident stated that they “did not like the food”. One resident who is a Moslem is provided with Halal meat. Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 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 the following standard(s): 16, 18 The home has a satisfactory complaints procedure that is accessible to residents and visitors so that they are aware of how to make a complaint ensuring the promotion of protection matters. EVIDENCE: There is a complaints policy and procedure that meets the required standard. Since the new manager started a complaints book and log have been available and comments from residents and visitors encouraged. One complaint was tracked and was evidenced as having been acted upon and the outcome documented. One resident said that they had had cause to make a complaint to the manager about the food and that it was dealt with and the food did improve. Another resident stated that they “would not be frightened to make a complaint if they had one to make.” The Adult Protection policy and procedure follows the Birmingham Local Guidelines, and a copy of the guidelines were available. Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Overall, the standard of the environment within this home is high, providing residents with an attractive, safe and homely place to live. EVIDENCE: A tour of the home was undertaken, all communal areas were seen, and a sample of residents bedrooms. An informal conversation with one of the housekeeping staff took place, and the inspector was informed that an extra member of the housekeeping staff had been employed. A new carpet cleaner had been bought and the areas of the home seen were very clean and fresh smelling. Housekeepers were observed to use the correct protective clothing and equipment when needed. One of the bathrooms had a “strange, musty smell” and the inspector was informed that as all rooms have ensuite facilities this bathroom was not used. There were further communal bathrooms available. There were new carpets in some of the communal areas, and furniture appeared to be in a generally good condition. The manager has identified the areas of the home that require decorating, and there is an ongoing programme to address this. Each house group has its own lounge and dining area. All corridors have handrails. Some Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 Page 16 residents were in the lounges and others preferred to stay in their bedrooms. Televisions, and music centres are available in each area. The bedrooms that were seen all had personal items, such as pictures photos, ornaments and in some cases, small items of furniture, which helped to enhance the homeliness of the rooms. Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 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 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 Overall the arrangements for staffing the home are sufficient to meet the needs of the residents, to ensure health and wellbeing. Overall the recruitment procedure protects the residents. EVIDENCE: Since the last inspection the numbers of qualified nurses on duty has been increased. There are now 3 in the morning, 2 in the afternoon and 1 at night. Numbers of care staff are stated as 8 in the morning, 7 in the afternoon and 4 at night. Where duty rotas indicate a shortfall relief staff are used to cover. The manager is supernumerary as are some of the hours of the deputy manager. A team of ancillary staff are employed including housekeepers, a head cook, assistant cook and kitchen assistant, dedicated laundry staff, a maintenance officer and administrator. The ratio of care staff with an NVQ level 2 exceeds the standard, and currently stands at 64 . Evidence was available that staff undertake training in the statutory areas of moving and handling, health and safety and fire training, although it was evidenced that some staff had not yet had their updated fire training. Staff interviewed confirmed this. All care staff recently underwent training in Palliative Care and the session for the trained nurses was planned for the month of May. Training in Tissue Viability is also provided, and a trainer comes into the home. Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 Page 18 A sample of 4 staff records were examined. The required documentation was present, and evidence seen that PIN number checks for trained staff had been carried out, and that staff have CRB and POVA checks carried out. Where a member of staff has been recruited via an agency, the manager must ensure that validation of the references provided by the agency is obtained. Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 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 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, 32, 33, 35, 36, 37, 38 The home has improved systems for consultation with residents where their views are both sought and acted upon. The management style of the home engenders an open and inclusive atmosphere The homes’ generally improved standard of record keeping safeguards the residents’ rights and best interests. The high standard of attention to the health and safety issues for staff and residents help promote and protect their health and welfare. EVIDENCE: The new acting manager has been in post since March 2006, and during that time has demonstrated a commitment to improving the service and care that the home offers, and evidence was seen that he has provided a much needed stability to the management of the home. He is a qualified RGN level1 and ENM, and although not currently holding a formal qualification in management, has many years experience of management within a care environment. Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 Page 20 Both staff, residents and visitors to the home commented on the fact that the manager often “walks the floor” and is much in evidence and available if people wish to speak to him or have any questions. An “open door” policy operates. There was evidence that there has been an increased resident centred ethos in the home, and the residents views and comments are sought and acted upon whenever possible. A Quality Assurance programme operates in the home, to ensure that standards are being improved, and this was evidenced as being the case. Staff meetings have been held to ensure that their views are aired and as a forum to improve the communication between the staff in the home. The records of formal staff supervision were varied, some staff having more than others, and the presentation was confusing and not easy to follow. Overall the standard of documentation and record keeping were seen to have improved since the last inspection, particularly in the areas of care planning, pre admission procedures, and general policies and procedures. An accident audit tool has been used to identify the number, frequency, time and place of accidents and falls, and it was evidenced that there has been a dramatic fall in accidents month by month, as appropriate action has been implemented. An audit of the management of the residents’ personal allowance management was carried out and a robust system was evidenced. Maintenance and safety checks were evidenced as being carried out at the appropriate intervals, including fire safety, PAT testing, Gas safety, and Electrical wiring checks. The risk assessment for the building was out of date, but the manager addressed this very quickly, and a copy forwarded to the Commission very soon after the inspection. The identification of maintenance issues has increased and evidence was seen that they are dealt with quickly. Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 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 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 3 3 Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 Page 22 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 15(1) Requirement Personal care/ hygiene plans must be in enough detail and available to care staff for them to be able deliver the care appropriately. This requirement is carried forward from 25/11/05. An assessment for the use of bedrails must clearly indicate that their use does not increase the risk of injury. This requirement is carried forward from 25/11/05. Regular staff drug audits must be performed to confirm the validity of the Medicine Administration Record (MAR) charts. Appropriate action must be taken when discrepancies are found. This requirement is carried forward from 25/11/05. There must be no gaps in the MAR if medication is not given the reason for this must be recorded. This requirement is carried forward from 25/11/05. Timescale for action 30/06/06 2 OP8 13(4)(c) (7) 30/06/06 3 OP9 13(2) 30/06/06 4 OP9 13(2) 30/06/06 Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 Page 23 5 6 OP9 OP9 13(2) 13(2) 7 OP9 13(2) 8 9 10 11 OP14 OP15 OP20 OP29 12(2)(3) 16(2)(1) 2(c) 19(1)(c) 12 OP30 18(1)(c) (i) 18(2) 13 OP36 The temperature of the drug fridge must be kept below 8 degrees centigrade. The person administering medication prescribed, as 1 or 2 tablets, or spoonfuls, to be given, must indicate on the chart what quantity has been administered. Consistent recording of a residents pulse rate prior to administering Digoxin, must be undertaken. Residents must be helped to exercise choice and control over their lives. Residents must receive a consistent quality balanced diet. The identified communal bathroom must be redecorated. References supplied to the home in respect of a member of staff employed via an agency must be validated. All staff must receive updated fire training, and any other training appropriate to the work they are to perform. All staff must receive regular and documented supervision. 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 31/08/06 30/06/06 30/06/06 30/06/06 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 Standard Good Practice Recommendations Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Kingfisher House DS0000063702.V290174.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!