Inspection on 22/07/05 for Mallard House

This inspection was carried out on 22nd July 2005.

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

Mallard House 13/02/08

Mallard House 08/05/06

Mallard House 24/11/05

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

CARE HOME ADULTS 18-65 Mallard House Dunthorne Way Grange Farm Milton Keynes, Bucks MK8 1ZZ Lead Inspector Joan Browne and Gill Wooldridge Announced 22 July 2005 09:20 a.m. 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Mallard House Version 1.10 Page 3 SERVICE INFORMATION Name of service Mallard House Address Dunthorne Way, Grange Farm, Milton Keynes, Bucks MK8 1ZZ 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) 01908 520022 01908 024533 P J Care Limited Agatha Coetzee Care Home 55 Category(ies) of Dementia (DE) (55) registration, with number of places Mallard House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1 2 26 Service Users with cognitive impairment 29 Service Users with early onset Dementia Date of last inspection N/A Brief Description of the Service: Mallard House is a 55 bedded nursing home on two floors which has been purpose built to provide accommodation for adults over 30 years of age with early onset dementia and acquired brain injury. The home is registered and the owner is an established provider of care in Buckinghamshire. The home is situated close to the centre of Milton Keynes and is close to public transport links. The home has its own transport which facilitates access to the community for residents. Support from other health professionals has been established within the local community. The staff team is developing to support the residents and care and nursing staff have an ongoing programme of training to support resident care. The garden is in the process of being completed. The addition of pictures and an increase in residents belongings as their numbers increase should ensure the environment develops a homely feel. Mallard House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place at 9.20am until 4.30 pm on 22nd July with a follow up visit on the 19th August 2005. The inspection was carried out by two inspectors, Joan Browne and Gill Wooldridge. The inspection consisted of a tour of the home, five care plans and assessments were studied and the care of residents tracked. Residents and staff were spoken to and lunch was observed. Medication records and staff personnel files were also studied. The manager, responsible individual and staff made contributions to the process of inspection and did not appear phased by the inspection process. The development of the service was discussed as were comments received from health professionals, relatives and residents. It is noted that the home is developing its systems which are supported by an enthusiastic staff team. This will need to be supported by quality audit systems and ongoing training and support to ensure residents’ needs are met. The care observed and described by staff and residents views were on the whole satisfactory with some good practice noted. Relatives did raise some concerns through comment cards and these were passed on to the manager. What the service does well: It was noted that residents and staff are developing positive relationships and there is an ongoing programme of training and support to ensure that the care of each resident is tailored to meet their needs. This is supported by some detailed care records. Staff described a supportive work environment and support from the manager The manager confirmed that recruitment of staff is supported by POVA and CRB checks. All staff undertake a clear induction and receive mandatory training to support their practice. The manager described open communication within the staff team which includes regular staff meetings and senior staff meetings. The manager described a good team spirit. Relatives meetings have taken place since the home has opened and more are planned in the coming months. Staffing levels appear to reflect the numbers of admissions. Good liason and support from a range of health professionals support the care of residents. Mallard House Version 1.10 Page 6 What has improved since the last inspection? What they could do better: 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. Mallard House Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Mallard House Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 & 3 Residents’ needs are thoroughly assessed which should ensure that the staff have a clear understanding of how to meet their needs. EVIDENCE: Several admission assessment were studied one of which detailed a resident spending time at the home for respite care. On the whole the documents clearly outlined a picture of the resident’s needs. Further occupational therapy and physiotherapist reports supported the process of assessment. It is noted that this is good practice and supported the residents and staff in the delivery of good care. The home’s assessment documentation covered areas such as personal fulfilment, spiritual, social, sexuality, cognition, communication, pain control, senses and many more. The written detail was clear and further supporting documentation from referring authorities was seen. The manager confirmed that she audits all assessments to ensure that the home can meet residents’ needs and any trial period should facilitate this process. The manager described ongoing support from a range of professionals with reviews of care with care managers. It is acknowledged that this process takes place but records relating to this practice should be maintained for Mallard House Version 1.10 Page 9 inspection purposes. The manger is requesting information from care managers. On the whole residents confirmed that their individual aspirations, needs and personal goals were met. However, some social and recreational needs identified in the documentation seen from referring authorities had not always been followed through into care plans. A quality audit system should ensure that any oversight is rectified. A respite care resident’s assessment file was studied and this indicated that ongoing risk assessment must support the process. There was no apparent risk assessment however, the care plan did refer to moving and handling concerns. A quality audit system will ensure that all documentation interrelates. Mallard House Version 1.10 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 & 9 Care plans are in place for all residents and are supported by a thorough process of assessment. However, some inconsistencies noted may effect the service delivery. Risk assessments are generally in place. However, some further detail will further support residents in maintaining their independence. EVIDENCE: Five care plans were studied and the residents’ care was tracked. Care plans covered areas such as personal care, nutrition, incontinence, diabetes, peg feeds and social activity. The care plans studied showed some good recording practice and well thought through care. However, the quality of the care plan was noted to be dependent on the authors. It is a requirement that the manager develops a quality audit system to ensure that care plans are consistently written with a positive slant in recording practice and that staffs approach is included. This must be supported by ongoing training for staff in care planning and good recording practice and include care plans giving clear detail relating to medical conditions Mallard House Version 1.10 Page 11 such as diabetes. Such a care plan should clearly describe, what is the normal range of blood sugars for the individual. This will assist any new members of staff assessment of any given situation. A detail of the symptoms relating to the resident’s condition will assist any new carer to raise any concerns with the trained nurse. It is recommended that blood pressure is taken monthly and recorded for all residents with diabetes. All temperatures, pulses and respiration (TPR’s) should be recorded regularly. It was noted that this practice varies in those records seen. Residents weights were recorded however, there were inconsistencies in the records seen. Not all care plans confirmed resident’s likes and dislikes. However, the manager stated that the chef is aware of resident’s food preferences, this was confirmed by the chef and consultation with residents’ family was described by the manager. Examples of good practice included clearly described approaches to service users and step by step instructions which would facilitate good care if the reader was a newly appointed staff member. For example, a care plan relating to staff approach described ‘avoid giving multiple choice as he may become frustrated,’ ‘requires limited options defined clearly.’ Residents’ preference for male or female staff to provide personal care was noted on the care plans. It is strongly recommended that where residents care plans state ‘nil by mouth’ this should be highlighted to ensure that the risk to residents is minimized. Any risk should form part of a risk assessment. Care plans relating to the care of residents’ skin indicated that nurses should seek advice from the tissue viability nurse and staff were using ‘Cavalon’ spray. Which is noted by evidence based practice. However, the assessment of the residents’ skin condition was not recorded consistently and staff had written ‘no longer at risk’ on the 18/7/05 previous to this the last record was dated 23/4/ the score indicated high risk. There was no apparent need to continue to review the residents pressure score risk assessment score. It was noted that the care plans seen showed that re assessment of the care plans had occurred in the first few weeks of admission on a weekly basis, this is acknowledged as good practice. Mallard House Version 1.10 Page 12 There was some confusion relating to staff comments in the daily log and whether these comments should have been part of the review of care, this was discussed with the manager who agreed that this was confusing. A further resident’s care was discussed regarding how staff could refer to a concern in a positive way and ensure the resident has specific recreational and social support to try to work with the presenting issue. Further to this the concern identified should be discussed in a multi disciplinarily forum with the resident and their representative to ensure that the risk is acceptable to all and to ensure that documentation supports the home in their duty of care. In relation to a specific incident and any perceived and described pattern of behaviour relating to a resident, the manager is reminded to inform the Commission of any event that effects the well being of a resident under Regulation 37 of the Care Homes Regulations 2001. Any perceived restriction of liberty should be documented fully in consultation with residents and their representative and reviewed in a multi disciplinarily process on a quarterly basis. As described earlier, the risk assessments are supported by ongoing support from the occupational therapist, physiotherapist and dietician. Records seen supported the staff statement of detailed assessments being carried out. The home is also supported by a neuro-psychiatrist, psychologist, speech therapist and is developing links with a local gym to facilitate further activities for residents. Training for carers in working with residents with dementia will facilitate meeting residents needs. The manger confirmed that this is in hand. One resident’s comments were concerning and the manager was advised to develop a behavioural chart and a formal agreement with clear guidelines for the resident and staff, this should ensure that any allegation is handled appropriately. It was noted at the follow up visit that reviews and care plans were in place. Residents described their care as meeting their needs and on the whole they were happy with the care, with one resident describing her personal goals as part of her care plan. Mallard House Version 1.10 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14, 15 & 17 Residents are presented with opportunities to access leisure activities both inhouse and in the wider community. Further choice and opportunities should be developed to ensure all residents social needs are met. Mallard House promotes flexible visiting which enables residents to maintain contact with family and friends. Residents are encouraged to discuss their meal preferences with the chef which should promote independence and choice. EVIDENCE: Mallard House Version 1.10 Page 14 Activities described by residents included small group activities including crafts, walks into town and fishing trips. The television was on in the lounge with one resident enjoying watching the cricket. Activities, including residents contributing to collages, were seen which were supported by the activity team. The home has its own transport which facilitates activities. Residents were seen to have a number of videos in their rooms and magazines to encourage their interests. Many bedrooms indicated the residents’ interests. During the follow up visit the owner and manager described having facilitated gym sessions twice a week and fortnightly golf sessions. Care plans relating to social activity have been discussed earlier in the report. It was noted from conversations with residents that a number of them were not interested in participating in making a collage. The manager must ensure that there are suitable activities for all residents throughout the day. It is acknowledged that a group of residents described going for a walk that morning and some residents were enjoying the garden space. The manager stated that the home is trying to develop links with a local gym to encourage further integration in the community and more opportunities for residents. The lunchtime meal was on the whole a relaxed experience on both floors with two choices of main course, all portions were large. The tables were laid attractively which added to the ambience. Some observed practice at lunchtime was sensitive and discrete and staff were seen to be sat next to residents and taking time and encouraging residents to respond. The responses from some residents included smiles and positive eye contact. Staff were heard to offer residents choices. The manager is asked to consider that a senior nurse assess the meal times process to ensure that the good practice seen is consistent. The chef was available during the mealtime and this indicated his role in quality assurance. Residents raised issues which he handled sensitively and he was able to acknowledge that the chips were soggy and confirmed this was an oversight and not the norm. It is acknowledged that the chef’s role in quality assurance relating to portion control and quality of the food is good practice. Relatives are encouraged to visit. However, some issues have been raised with the Commission and the manager, it is anticipated that these teething problems will be resolved. Mallard House Version 1.10 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 & 20 Staff observed practice should demonstrate that residents’ physical and emotional needs are met. Medication procedures are in place however; good recording practice and a further quality audit system need to be in place to protect residents. EVIDENCE: It was noted that all personal care was carried out in bathrooms and bedrooms which helped to maintain residents’ privacy and dignity. Preference of a female or male staff members to carry out personal care was indicated in care plans seen. There was some evidence of resident distress during the inspection which appeared to impact on other residents. They indicated that they did not like the noise. Staff did handle a potentially difficult situation well. However, a nurses presence in the communal areas might ensure the level of distress is kept to a minimum. Staff were seen to respond quickly to a situation that arose after lunch. It is important that the approach relating to any resident in distress is part of a care plan. Mallard House Version 1.10 Page 16 Staff practice relating to the administration of medication was not observed at this inspection however, Medication Administration Records (MAR) sheets were viewed. On the whole staff recording practice was satisfactory however, one entry indicated that staff had written over an entry this practice must cease and staff must be reminded of their accountability relating to Nursing and Midwives Council (NMC) Code of Conduct. Records must be kept of these discussions for inspection purposes. A more frequent quality audit of (MAR) sheets will ensure that errors do not occur. It is strongly recommended that the manager developed individual PRN management plans for the medication of any resident which may be perceived as controlling behaviour or having a sedative effect. It is strongly recommended that a clear protocol supports care plans relating to residents needs regarding medical conditions such as diabetes. Mallard House Version 1.10 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Although there is a complaints procedure, some verbal concerns are not always recorded. Recording of these verbal concerns should ensure that residents and relatives views are listened to and acted upon. Policies and procedures are in place which should ensure that residents are protected from abuse. EVIDENCE: The manager described a recent concern raised by a residents family. It is strongly recommended that the manager record any verbal concerns and issues that relatives raise and that these are written to relating to a clear action plan and explanation. From discussions with residents it was evident that they are listened to and there view is that the care is good. Staff were able to identify any potential or actual abuse and described a clear reporting process. Staff stated that shouting at a resident was unacceptable. Policies and procedures are in place to support staff practice. This should ensure residents are protected from abuse. Mallard House Version 1.10 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 27 & 30 The environment has been designed to ensure that residents reside in an environment that meets their care and comfort needs. The addition of pictures should facilitate a more homely feel as will the completion of the garden. Standards of cleanliness in the home are good which should ensure that residents live in a clean home. EVIDENCE: The home was clean and tidy with no odour of incontinence. However, the home had a clinical feel. The proprietor confirmed that pictures are on order to provide a more homely environment. The home has adequate storage space which ensures that equipment is stored appropriately. The kitchenettes and bathrooms were clean and tidy. Cereals were stored in airtight containers. Staff were observed to maintain good hygiene practice and described hand washing as a key to infection control. Staff were seen to wear gloves and aprons to aid infection control and pedal bins also aid the process. Some residents’ bedrooms indicated their personality, interests and hobbies and Mallard House Version 1.10 Page 19 some residents had been encouraged to bring items of furniture into the home. Some residents have a key to their own bedroom. Gloves were seen in bathrooms it is recommended that discreet storage be provided. Hot water temperatures were noted to be within the acceptable range. The laundry area was impressive with a dryer that is computerised to advice you when it needs to be cleared of fluff. The washing machines work with ozone which disinfects the clothes. The gardens are in need of some work so that they can be fully accessed by residents. It is acknowledged that as residents numbers increase and then continue to bring into the home their belongings the environment will take on a more homely feel as will the addition of pictures in the corridors. Mallard House Version 1.10 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34 & 35 Recruitment procedures at the home appear robust and along with the implementation of the requirement should ensure that residents are appropriately protected. The staffing levels and continuing emphasis on appropriate staff training should benefit residents’ care. EVIDENCE: Staff rotas indicate that staffing levels are adequate to meet residents’ needs. The manager described ongoing recruitment to coincide with the increase of resident numbers. Staffing numbers during the inspection appeared to meet residents’ needs. The manager acknowledges that the team is new and that ongoing training and support is the key to building an effective staff team. The manager confirmed there is planned training for care staff in working with residents with dementia and acquired brain injury, this should ensure residents needs are met Staff spoken to described clearly their roles and senior staff were aware of their accountability. Newer staff appeared to need some further direction, it Mallard House Version 1.10 Page 21 is acknowledged that they were shadowing more experienced staff but it may have been disconcerting for residents to have staff apparently standing around. It is strongly recommended that senior nurses are asked to be seen to support, residents and junior staff during the meals. A staff member described not being totally confident in using a hoist and she described asking a more experienced staff member for support. It may be prudent for the manager to check out with staff regarding their confidence in using equipment and offer staff who are not confident further training. Trained nurses clearly defined the care of residents, this detail was not always evident in the care plans. Two staff personnel file were studied, prospective employers fill in an application form and the home requests two references, these were evident on both files, however, these references were copies and it is recommended that the proprietor requests an original for the home’s records. The manager and responsible individual were informed of the advice to inspectors recently being given by the Commission’s legal department. The advice states that all employees recently employed from abroad must be CRB checked including POVA First check. This is a requirement of this report, which may appear contrary to the advice given to the proprietor recently. The proprietor and manager are aware that staff must be supernumerary until these checks are carried out. It was confirmed by the manager that it is the norm for these checks to be carried out by the home for those staff employed already working in the UK. Work permits were in place where appropriate as was a health declaration and job offer with terms and conditions. Mallard House Version 1.10 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Healthy and safety information was examined through out the registration process and indicates that residents health, safety and welfare is promoted and protected. EVIDENCE: A large number of health and safety documents were studied during the registration process. Along with fire officers and environmental health officers reports which supported the process. Healthy and safety information was examined through out the registration process and indicates that residents health, safety and welfare is promoted and protected. Mallard House Version 1.10 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 3 x x 3 Standard No 11 12 13 14 15 16 17 x x x 2 3 x 3 Standard No 31 32 33 34 35 36 Score x 3 x 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x x x Mallard House Version 1.10 Page 24 N/A Are there any outstanding requirements from the last inspection? Mallard House Version 1.10 Page 25 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 6 Regulation 15 (b) Requirement The manager must ensure that all care plans are reflective of residents needs and ensure an overall standard of care plans. This must be supported by ongoing training for staff in care planning and good recording practice. The manager must inform the Commission of any event that effects the well being of a resident under Regulation 37 of the Care Homes Regulations 2001. The manager must ensure that any perceived restriction of liberty or concern as detailed in the care plans are discussed in a multi disciplinarily forum with the resident and their representative to ensure that the risk is acceptable to all and to ensure that documentation supports the home in their duty of care. Review should be quarterly and the home must maintain records for inspection purposes. The manager and proprietor are required to ensure that all staff employed in the home are subject to a CRB and POVA check before their employments commences. Timescale for action 31/01/06 2 6 37 30/9/05 3 9 13 (4) 30/9/06 4 34 19 Schedule 2&4 30/9/05 Mallard House Version 1.10 Page 26 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 2&3 Good Practice Recommendations It is recommended that the manager develop a quality audit system to ensure documents interrelate including assessments care plans and risk assessments and consultation with residents relatives and care managers supports the process. It is recommended that blood pressure is taken monthly and recorded for all residents with diabetes. All temperatures, pulses and respiration (TPR’s) should be recorded regularly. All residents weights should be recorded regularly. It is strongly recommended where residents have stated on their care plan ‘nil by mouth’ this should be highlighted to ensure that the risk to residents is minimized and all staff must ensure any risk is identified on a risk assessment. It is strongly recommended that the manager develops the range of activities to support residents’ choice. Quality audits and discussions with staff about their accountability should ensure medication errors are not the norm. It is strongly recommended that the manager develope individual PRN management plans for residents for medications that may be perceived as controlling behaviour or having a sedative effect. It is strongly recommended that a clear protocol supports care plans relating to residents needs relating to medical conditions such as diabetes. 2 6 3 6&9 4 5 14 20 Mallard House Version 1.10 Page 27 Commission for Social Care Inspection Cambridge House, 8 Bell Business Park Smeaton Close Aylesbury Buckinghamshire HP19 8JR 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 Mallard House Version 1.10 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!