Inspection on 29/10/08 for Lea Green Court

This inspection was carried out on 29th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lea Green Court 25/06/09

Lea Green Court 23/02/09

Lea Green Court 01/07/08

Lea Green Court 17/07/07

Lea Green Court 10/07/06

Lea Green Court 24/10/05

Lea Green Court 13/06/05

Lea Green Court 23/09/04

Lea Green Court 10/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lea Green Court Kenton Road Gosforth Newcastle Upon Tyne NE3 3UW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elaine Charlton     Date: 2 9 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Lea Green Court Kenton Road Gosforth Newcastle Upon Tyne NE3 3UW 01912851720 01912851960 lea_green.court@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Tamaris Healthcare (England) Ltd care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: One named service user is under 65 years of age, category DE. No further admissions are permitted in this category without the prior agreement of CSCI. Date of last inspection Brief description of the care home Lea Green Court care home provides nursing care for older people with enduring mental health problems. Care in the home is provided by Registered Mental Nurses supported by care staff. The home is owned and managed by Four Seasons Healthcare Limited a large provider of care services to vulnerable client groups. It is situated in Gosforth on the outskirts of Newcastle upon Tyne close to local shops and good public transport links. There are 45 single bedrooms located at ground or first floor levels, and there is a passenger lift to help people who may have difficulty with stairs. Most bedrooms have en-suite facilities, those that do not have a wash hand basin and are close to bathroom, toilet and shower facilities. On each floor there are separate lounge and dining room areas, and a number of toilets and bathrooms. The home also has its own kitchen and laundry facilities. Fees in the home are between £421 - £616 per week. They are dependent on they type of service provided and whether the placement is privately funded or not. Care Homes for Older People Page 4 of 31 Over 65 45 0 Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced visit was made on the 29 October 2008. The purpose of the inspection was to monitor the progress being made to meet the requirements and recommendations made at the earlier inspection on the 1 July 2008. Almost eight hours were spent in the home. The manager was present throughout the inspection. Before the visit we looked at Information we have received since the last visit on 1 July 2008. How the service has dealt with any complaints and concerns since the last visit. Any changes to how the service is run. The providers view of how well they care for people. The views of people who use the service, their relatives, staff and other professionals who visit the Care Homes for Older People Page 6 of 31 service. During the visit we Talked with people who use the service, staff, and the manager. Arranged for an inspection of medicines and the medication administration systems to be carried out by a CSCI Pharmacist. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. We told the manager what we found. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 31 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their relatives are given good information to help them decide about moving into the home. Their needs and wishes are fully assessed so that everyone is sure they can be met. Evidence: Full professional assessments are obtained from Local Authority, healthcare professional and hospital based staff before people are admitted into the home. The company has its own Dependency Assessment Rating Tool (DART) that is completed as part of the homes assessment of its own ability to meet the needs of people who may want to move into the home. Additional assessments are carried out and recorded using recognised assessment tools to see what level of support people living in the home might need with pressure Care Homes for Older People Page 11 of 31 Evidence: area care, continence, nutrition and any deteriorating or enduring mental health issues. This continues to mean that the diverse needs of people who may be admitted to the home are known and everyone can be sure these needs can be met. The home does not provide intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are asked how they wish their personal care to be provided and by whom, but recordings and evaluations of care plans are not always legible or of a good quality. Record keeping in the home could be improved to demonstrate that people are receiving all of their medication as prescribed and to ensure that medicines remain secure and suitable for use. Evidence: We looked at assessments for people who were already living in the home and for two people who had recently been admitted. In the new files we saw better quality information and they were more organised. Some of the care plan evaluations we saw had improved, but writing in others was illegible. This makes it difficult to for staff to be sure what they should be doing, and what care and support they should be providing. Care Homes for Older People Page 13 of 31 Evidence: We saw evidence of advice, support and the intervention of healthcare professionals being sought to support people with their illnesses, changes in their healthcare needs and behaviours that may challenge normal daily routines. For one person their assessment said there was the possibilty of allegations being made against staff. The care plan detailed that two carers should be present at all times, and that the care plan should be evaluated on a weekly basis starting from February 2008. The evaluations had not been carried out on a weekly basis. There has been a limited improvement in the quality and content of recordings in care plans and evaluations. But record keeping could be improved to demonstrate that people are receiving all of their medication as prescribed and to ensure medicines remain secure and suitable for use. There were no significant gaps on the medicine administration record (MAR) charts but the quantity of some medicines carried over from one month to another is not recorded.This means it is difficult to have a complete record of medication within the home and to check if medication is being administered as prescribed. The date of opening of medicines with limited use once opened is not always recorded.This means there is a risk that medication may be used beyond the date recommended by the manufacturer and may not be safe to administer. Handwritten entries on MAR charts were generally well documented but occasionally were not dated, signed or countersigned. The treatment room used to store medication is small and at the time of the visit a wheelchair was stored there and batteries were in the process of being recharged on the bench top. Some ointments were stored in a wall cupboard which was not locked. Some supplies of nutritional supplements were located in a cardboard box on the floor rather than in a secure cupboard. The medication policy although extensive, does not provide enough detailed information on how the home obtains and disposes of medication. Medicine administration was observed on the first floor and was generally seen to be in accordance with recommended practice although the nurse involved recorded the medication as being given before witnessing the person taking all the medication. Time was spent with each person and encouragement given to help them take their medication. Care Homes for Older People Page 14 of 31 Evidence: The controlled drugs cupboard appears to meet safe custody regulations and there were no discrepancies between in the controlled drug register and medication held in the home. There was no evidence of any regular controlled drug stock checks and one entry for the receipt of Midazolam had not been signed and countersigned. Small volumes of liquid medicines were being measured with ordinary syringes used to administer injections rather than with oral syringes designed to administer liquid medicines safely. Although the temperature of the refrigerator is measured regularly a maximum/ minimum thermometer is not used, which means that fluctuations in temperature within the refrigerator are not recorded. Some medication was found in the wall cupboard which no longer had a dispensing label attached. Only medicines dispensed, labelled and currently prescribed for residents should be kept, and any unwanted medication should be disposed of in the usual way. Whilst we walked around the home we saw staff talking to people and helping them to move around in a quite and sensitive way. There was a lot of quiet, appropriate conversation taking place between staff and residents. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to use all areas of the home as they wish. Relatives are encouraged to visit and activities and social opportunities are increasing to provide people who live in the home with interesting and stimulating opportunities. Evidence: Planned activities in the home are still limited but a new activities co-ordinator has been appointed. This will become a full time post from the New Year. The activities co-ordinator had started to make notes in care plans about peoples interests adn things they have previously enjoyed taking part in. These were very nice and well written. A number of staff were due to attend driver training so that they could take one of the company mini-buses out. This will mean that regular use of a mini-bus can be made to give residents access to outings and the wider community. It was thought this could become a fortnightly event. We were told that some new tactile equipment and an indoor golf set had been Care Homes for Older People Page 16 of 31 Evidence: purchased. Visitors are always welcome in the home and some relatives spend a lot of time with their loved ones. We sampled all the lunchtime menu choices. People were offered pork with boiled potatoes, beans, cauliflower and stuffing or an omelette. Both choices were fresh, hot, tasty and very nicely presented. The kitchen was clean and well organised. Cupboards were well stocked with products like cereal, biscuits, bread, there was also a range of small tinned items avaiable in case anyone did not want the lunch time choices, or requeted a snack. A buffet tea had been prepared and was stored in a chilled area. There was a good selection of sandwiches, plates of small pieces of pork pie, sausage rolls, boiled eggs, nibbles, jam doughnuts. Lunch for the downstairs dining room was served from the hot trolley in the kitchen, directly to staff on the other side of the serving hatch. Drinks, cups and napkins were all to hand and easy for staff to give to residents. Upstairs food is again served direct from the hot trolley. As we walked around the home we heard a radio being planned very loudly. The manager told us that a gentleman who uses the lounge turns the radio right up. Staff had not taken any action to lower the tone. They need to be very aware when this takes place as it was extremely unpleasant for people sitting in the lounge. We were told that the relatives of a resident who has a musical key board have said they were happy for the key board to be used for the enjoyment of other residents at parties and other events. This is a lovely gesture. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are protected from harm through policies, procedures and on-going staff training in safeguarding adults. Relatives know who to speak to if they are unhappy or wish to make a complaint and can be confident that issues will be properly dealt with. Evidence: The company has policies and procedures in palce for the acceptance, recording, and investigation of complaints. We were told that monthly summaries of complaints and compliments are sent to the Regional Manager. These are also checked as part of the provider Regulation 26 visits. We were told that there is an on-going programme of Protection of Vulnerable Adults (POVA) training and that staff are also completing the company workbook on this subject. When a staff member completes their workbook it goes to the manager for evaluation. Nurses and carers are to receive training on the Mental Capacity Act. It is then intended that all other members of the staff team will attend a similar course. The organisation has a whistle blowing policy that encourages people to disclose any poor practice they may witness. Care Homes for Older People Page 18 of 31 Evidence: The manager is aware of the need to report people considered unsuitable to work with vulnerable adults to the POVA register and or the Nursing and Midwifery Council (NMC). Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home where they can move around safely both inside and outside. Some areas of the home are still in need of redecoration and renovation which will make it more comfortable for residents. The home is generally clean but good hygiene routines are not always followed. Evidence: When we arrived to carry out the inspection we noticed that the orientation board on the ground floor said it was Monday the 27 October. The inspection took place on the 29 October. Relatives have previously raised the issue of these boards not being updated regularly, and sometimes not being completed at all. We identfied seven bedrooms to look at as we walked around the home. These bedrooms were all clean and tidy and some had been personalised by the resident or their family. Nurse call leads were not in place in each of the bedrooms we saw. We were told that where there was a risk of the resident hurting themself with the lead, additional and more frequent checks were carried out to promote their well being. New dining room tables and chairs have been purchased. The floor coverings in the Care Homes for Older People Page 20 of 31 Evidence: dining rooms have been replaced and restrictors have been fitted to first floor windows where they had been missing or were broken. The main corridors have been redecorated and this has made the areas much brighter. We talked to the manager about the difference in corridor lighting where brighter flourescent tubes had been put in. In one corridor there was a significant difference depending which way you were facing. There is an on-going programme of redecoration. The floor in one of the assisted bathrooms has become cracked in the area of the bath hoist. The Estates Department were due to visit to assess whether it could be changed into a wet room. One of the newly decorated bathrooms has one wall covered with a mural, it has made the room somewhere pleasant to spend time and relax whilst bathing. Pull cords in dining and sitting rooms had been tied up around the lights. No one was able to explain why. In toilets and bathrooms the pull cords were dirty and needed to be replaced. We also saw waste bins being used that were not foot operated and did not promote good infection control. The laundry is fitted with three washing machines and two tumble dryers. Both dryers have recently been replaced. All the machines can be programmed for different washes, sluicing and drying temperatures. We spoke to the laundry assistant who talked about how tasks are carried out, and how clothes are returned to the residents. She had everything very much under control and was extremely well organised. We discussed with the Operations Manager, who was also present during the inspection, the odour in the ground floor corridor. Even though the carpets have undergone extensive washing the odour is still evident as soon as you enter the home. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People working in the home are properly recruited and the residents know they are trained and able to help them with the care and support they need, some training is still in need of updating. Evidence: The company has comprehensive policies and procedures in place for the proper recruitment and selection of staff. We looked at the records for four people recently recruited to work in the home. Everyone had completed an application form, references had been sent for and notes had been added when follow up telephone calls were made to verify the person giving a reference was who they said they were. We saw evidence of Criminal Record Bureau (CRB) checks being carried out and all nurses Personal Identification Numbers (PINs) had been checked to make sure they were up to date. We were told that it is the managers responsibility to ensure that these checks are renewed as and when necessary. The manager has a new file in place where evidence of nurses PIN number checks is kept. She also has a summary sheet in place that identifies renewal dates. Care Homes for Older People Page 22 of 31 Evidence: Each member of staff is to get their own individual training file. We were also given a copy of the new training matrix and plan. A lot of training has already taken place to bring staff skills and knowledge up to date in the mandatory areas of safeguarding adults, moving and transferring, health and safety, fire safty and first aid. We were told that everyone was due to be issued with an infection control workbook. Other areas of training needing to be delivered include tissue viability and care planning. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home that is increasingly being run in an open and inclusive way, promoting their best interests, safety and wellbeing. Evidence: The manager has submitted her application to CSCI to become the registered manager at Lea Green Court. We looked at the accident book recordings and follow actions taken in the event of an incident taking place. Some of the entries recording accidents included information that was speculative. For example, dozing in chair it would appear he has leant forward and toppled onto the floor. The follow up action was to put the resident in a reclining chair. A number of accident follow up actions were noted as close observation. This included no details of by whom, or how often or whether additional recordings should be made. Care Homes for Older People Page 24 of 31 Evidence: We checked the homes fire log. Statutory checks are carried out and recorded as required by the Fire Officer. We were told that there was also a new home fire risk assessment in place. Maintenance and servicing contracts are in place gas safety, electrical circuits, portable appliances, fire alarm systems, nurse call system, passenger lift and hoists. Medical equipment used in the home had been tested and calibrated to make sure that it was all working effectively. A member of the regional administrative team was also in the home carrying out an audit of administrative and financial systems. She told us that these are done regularly and are usually unannounced. The organisation has a comprehensive range of policies and procedures that are easily accessible by staff and support them to do their job. A programme of regular supervision and appraisal has started. We were given a copy of the new schedule supporting this. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be improved 01/12/2008 to reflect the information provided in the assessment of a persons needs. This will mean that people living in the home will receive the right care and support to keep them safe and well. 2 7 15 Care plans must be properly 01/12/2008 reviewed and evaluations recorded in an outcome focused way. This will mean that the benefit a resident has received from receiving care and support in a person centred way is recorded. 3 27 18 The level of domestic support 01/12/2008 in the home must be reviewed to make sure that sufficient people are employed to maintain good infection control and hygiene routines. This will mean that people live in a clean, hygienic and odour free home. Staff must receive regular, 01/12/2008 recorded supervision and appraisal. This will mean that they are supported and Page 26 of 31 4 36 18 Care Homes for Older People helped to do their job. Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Best practice guidance and 31/12/2009 the providers current procedures must be followed when medicines are received into the home and when giving and recording medicines. This will help demonstrate that medicines are given as prescribed thereby protecting the health of people living in the home. 2 24 23 The carpets in the entrance hall and ground floor corridor must be replaced. This will remove the odour in this area making the environment more comfortable and pleasant. 29/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 31 1 9 Staff should sign and date handwritten entries they make on the MAR charts. Each entry should be checked and countersigned by a second person to reduce the risk of error when copying information. The treatment room should be used solely for the storage of medicines and related healthcare products and only staff who handle medicines should have access to this area. Surplus medicines no longer required should be disposed of promptly. This helps when stock taking and reduces the risk of out of date medicines being administered. The medicines policy should be updated to reflect local requirements and practices within the home including guidance on the supply and disposal of medicines. Providing clear and up to date guidance will help staff understand how to handle and administer medicines safely. A system should be in place to record all medication received into the home and carried over from a previous month. This helps to confirm that medication is being given as prescribed and assists in checking stock levels. An adequate supply of oral syringes should be available on the medicines trolley to measure small volumes of oral liquid medicines. Syringes intended for the administration of injections should not be used to measure or administer oral liquid medicines. A maximum/minimum thermometer should be used to monitor the fridge temperature to confirm that medicines are stored within the appropriate temperature range and so are safe to use. The programme for the delivery of Protection of Vulnerable Adult training should continue to make sure that all staff have completed this. This wil help to make sure that people who live in the home are kept safe. Emergency pull cords should not be tied up out of residents reach. This could mean that they are not able to call for someone if there is an incident or someone is unwell. The orientation boards displayed on each floor should be kept up to date so that they are meaningful and help people to be reminded of dates, the weather, lunch and anything that it taking place. All waste disposal bins should be foot operated to promote good hygiene routines and infection control. Pull cords in toilets and bathroom should be regularly checked and replaced to promote good hygiene routines and infection control. 2 9 3 9 4 9 5 9 6 9 7 9 8 18 9 19 10 19 11 12 26 26 Care Homes for Older People Page 29 of 31 13 38 Follow up actions and or monitoring in the event of an accident taking place should be clearly noted in the accident record and the residents care plan where appropriate. This will help to keep people who live in the home safe and well. Staff involved in the recording of accidents should not record speculation. Records should be factual and legible. 14 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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