Inspection on 09/06/09 for Mapleford

This inspection was carried out on 9th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mapleford 10/02/10

Mapleford 07/12/09

Mapleford 01/10/09

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Mapleford Bolton Avenue Accrington Lancs BB5 6HN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Hargreaves     Date: 0 9 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Mapleford Bolton Avenue Accrington Lancs BB5 6HN 01254871255 01254231768 mapleford@fsmail.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mapleford (Nursing Home) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following categories of service only: Care home nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disabilities or dementia - Code MD, Dementia - Code DE. Maximum number of service users who can be accommodated is: 54 Date of last inspection Brief description of the care home Mapleford is a purpose built care home set in its own grounds. It is situated in a residential area of Huncoat close to shops and a Church. It is on a bus route to the town of Accrington which is about 2 miles away. Mapleford provides 24 hour nursing and personal care for up 54 people suffering from dementia or mental health problems. Accommodation is provided in mostly single Care Homes for Older People Page 4 of 29 Over 65 54 54 54 54 Brief description of the care home rooms and 7 double rooms. Some of the bedrooms have en-suite facilities. There are 3 lounges each with with a dining area. A passenger lift facilitates access to all areas of the home. The current fess charged at Mapleford are £430.50 - £1093.01 per week. A copy of the statement of purpose and service user guide is available to people who are considering using the service and their relatives on request. Care Homes for Older People Page 5 of 29 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: A key or main unannounced inspection, which included a visit to the home, was conducted at Mapleford on 9 June 2009. This is the first inspection after the home was registered with the Care Quality Commission following a change of owner. The manager completed an Annual Quality Assurance Assessment several weeks before the visit. This document is a self-assessment that focuses on how well outcomes are being met for people who use the service. It also gives some numerical information about the service. Five completed surveys were returned from members of staff. At the time of this visit thirty five people were living at the home. A tour of the premises took place and we looked at staff files and care records. We also spoke to members of staff on duty, people who use the service and their visitors. Discussions Care Homes for Older People Page 6 of 29 also took place with manager and area manager regarding issues raised during the inspection. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Care plans must identify the health and personal care needs of each person using the service and provide clear directions for staff to follow in order to ensure their needs are met. To make sure members of staff have up to date information about the care needs of each person care plans should be reviewed monthly and up dated when the needs of the person change. Risk assessments for falls, nutrition and the development of pressure sores must be completed for each person using the service. This will enable a care plan to be developed explaining exactly what staff need to do in order to effectively manage any identified risks. Prompt action must be taken to improve the management of medication. An accurate record of all medication received into the home must be kept. This will make sure all medicines can be fully accounted for. To ensure people receive the treatment they need medication must be given to them as prescribed by the doctor. Receiving medicines at the wrong time, wrong dose or not at all can seriously affect a persons health and wellbeing. The records kept for people who look after their own medication should be reviewed to make sure this is done safely. Rooms where equipment is stored must be kept locked in order to prevent people using the service from being injured if they mistakenly enter these rooms. People using the service must be able to access the nurse call bell and if necessary an extension lead should be fitted to enable people to ask for help when they are in bed. To promote the wellbeing of people using the service action must be taken to deal with the unpleasant odour in several of the bedrooms. Care Homes for Older People Page 8 of 29 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 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. A thorough admission procedure ensured the health and personal care needs of people using the service were identified and met. Evidence: A copy of the statement of purpose and service user guide is available to people who are considering using the service and their relatives on request. These supply information about the care and facilities provided at the home. The manager or a senior member of staff visited people who were considering using the service in hospital or their own home before admission. The purpose of this visit is to assess the persons health and personal care needs to ensure they can be met at the home. We looked at the care records of three people using the service. Pre-admission assessments were seen in all three files. These assessments provided important Care Homes for Older People Page 11 of 29 Evidence: information for the development of their care plans. People considering using the service or their relatives received a letter of welcome confirming that their needs could be met at the home. Care Homes for Older People Page 12 of 29 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 who use the service were cared for in a manner which promoted their privacy and dignity. Deficiencies in the management of medication could affect the health and wellbeing of some people using the service. Evidence: We looked at the care plans of three people who use the service. Two of these plans identified the health and social care needs of each person and provided some directions for staff to follow to ensure their individual needs were met. The care plan for one person clearly explained the action that staff needed to take in order to prevent anxiety. Another care plan advised staff to approach the person in a particular way to prevent them from becoming agitated. The other care plan we looked at was for a person admitted recently to the home. This plan contained only brief information about their dietary likes and dislikes and preferred daily routine. Health and personal care needs were not clearly identified and there was no guidance for staff to follow to ensure this persons needs were met in the Care Homes for Older People Page 13 of 29 Evidence: way that they wanted. Risk assessments for falls, nutrition and the development of pressure sores had not been completed. These make sure risks are accurately identified so that if necessary a care plan can be developed explaining how these risks are to be managed. However, discussion with members of staff confirmed that they had a good understanding of the health and personal care needs of people using the service. One member of staff explained that the manager told them about the care a person needed when they were admitted to the home before a detailed care plan was in place. A report about the care given to each person using the service was written during each shift. This ensured that all staff had up to date information about the condition of each person in order to ensure continuity of their care. Although care plans were reviewed this was not done routinely every month. The care plan for one person had only been reviewed twice this year. When there were any changes to the care needs of the person these were usually recorded in the evaluation section of the records instead of the care plan. Reviewing care plans every month and up dating them when the needs of the person changes ensures members of staff know exactly what they need to do to in order meet the individual needs of each person. Where possible the person using the service or their relatives were involved in care planning and signed the care plan to indicate their agreement with the care provided. There were records of the involvement of GPs and other healthcare professionals including the chiropodist and optician in the care of people who use the service. Personal care was carried out in the privacy of the persons own room or the bathroom. Members of staff were observed attending to people in a polite and friendly manner. One person said, The staff are really nice. As part of the visit a pharmacist inspector checked how medicines were being handled. We checked medicines records, medicines stock and spoke with three members of staff. When we arrived at the home the morning medicines round was just being completed. We observed a nurse sign the records of medicines given for 18 residents at the end of the medicines round, this is poor practice as records should be signed immediately after a person has taken their medicines to help prevent mistakes. The nurse offered no reason why the records had not been signed properly at the right time. When we checked the records of these 18 residents we found some of the morning and all of the Care Homes for Older People Page 14 of 29 Evidence: lunchtime and teatime medicines had not been signed for on the previous day. We checked the stock of these medicines and found that they had probably been given but had not been signed for. The manager agreed that this was poor practice as staff were not following the procedures of the home and recommended best practice. The manager said recent audits (checks of the medicines) had found the same problems and so she had spoken to all staff about their continued failure to make accurate records. We looked at a further sample of medicines records and saw numerous gaps where staff had forgotten to sign. Insulin was not always signed for and blood sugar tests were not always recorded. We found medicines in packets and bottles were often difficult to account for as the records of receipt and records of medicines carried forward were not always accurate. Poor record keeping and failing to follow correct procedures when handling medicines can result in mistakes that might seriously affect a persons health and wellbeing. We looked at a sample of care plans and records to check if medicines were properly reflected in them. We found some good information for some medicines such as pain killers and medicines used for anxiety but we found this information missing for several people so there was a risk that they might not get their medicines given to them properly. People that were looking after their own medicines were helped by staff to do so, however, the paperwork to support this was not always up to date. We gave some advice to the manager about how to make improvements to help make sure these medicines are handled safely. We checked how controlled drugs (medicines that can be misused) were handled. A suitable cupboard was used for storage to help make sure they were safely kept. A special register was used for record keeping and the entries we checked were usually witnessed, accurate and complete. However, a strong pain relief patch for one person was applied two days late because staff had forgotten to replace it, which means this person might have suffered pain. This showed that some staff were not always checking the records correctly when giving and recording medicines. Care Homes for Older People Page 15 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples choices were respected and they were supported by members of staff to have a fulfilling lifestyle. meals were wholesome and appetising and people enjoyed them. Evidence: Discussion with people using the service and members of staff confirmed that a variety of activities were organised in the home. These included playing cards, dominoes, manicures, exercises, chatting to people individually and taking people out for walks. There was a small size snooker table in one of the lounges for people to use when they wanted. During the morning of this visit people sitting in the lounge were listening to the radio and members of staff frequently offered them drinks and briefly chatted to people. This provided a pleasant and homely atmosphere for people using the service. A member of staff was employed on weekday afternoons to organise activities. On the afternoon of this visit she took several people out in the mini-bus. One visitor said they had recently held a 60s and 70s afternoon with karaoke and a buffet. This had been advertised in the home and the friends and relatives of people using the service had been invited. Care Homes for Older People Page 16 of 29 Evidence: People using the service and members of staff said that visitors were welcomed into the home and offered refreshments and meals. The visitors of one person said, We come every week, the staff are friendly and always bring us a drink. The daily routine was flexible in order to meet the needs and preferences of people using the service. All the people asked said they could choose when to get up and go to bed. One person said, I get up and go to bed when i want. The meal served at lunchtime looked wholesome and appetising. the cook explained that blended meals were served with each item of food blended separately. This meant people could identify the food and experience the individual flavours. Special diets and the individual likes and dislikes of people using the service were catered for. All the people asked said the meals were good. However, one visitor considered that more vegetables would improve the meals. Care Homes for Older People Page 17 of 29 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. Complaints were taken seriously and investigated. Members of staff had the training necessary to ensure people who use the service were protected from abuse. Evidence: A copy of the statement of purpose and service suer guide was displayed in each bedroom and included in the statement of purpose and service user guide. The five members of staff who completed the survey indicated that they knew what to do if a person using the service or their relatives expressed any concerns to them. The manager had investigated and resolved one complaint since the ownership of the home had changed. No complaints have been made directly to the Commission. We looked at the policies and procedures for safeguarding vulnerable adults. The procedure clearly stated the action that members of staff must take if allegations of abuse are made. Discussion with two members of staff confirmed that they had received training in safeguarding vulnerable adults. They both said they would report any concerns to the manager immediately. Care Homes for Older People Page 18 of 29 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. The premises provided a comfortable and homely environment for people who use the service. Evidence: A tour of the premises confirmed that the home was clean, tidy and generally well maintained. This provided a homely and comfortable environment for people using the service. However, there was strong smell of urine in several bedrooms. An unpleasant odour does not promote the health and wellbeing of the people who use these rooms. We also found that in some of the bedrooms the nurse call bells were not fitted with an extension lead and were not within reach of a person if they needed to summon help when they were in bed. If it is unsafe for a person using the service to be provided with an extension lead for the call bell this should be subject to a risk assessment and recorded in their care plan. People using the service were encouraged to bring personal items for their bedrooms to make them more homely. These included, ornaments, photographs, pictures for the walls and items of furniture. A room near a lounge on the ground floor was used for storing wheelchairs, weighing scales and other items of equipment was not locked. The door to another room used for storing bedrails and bedding did not close properly and a member of staff said they Care Homes for Older People Page 19 of 29 Evidence: had never known this door to be locked. Leaving storeroom doors unlocked could put people using the service at risk of injury if they mistakenly went into these rooms. To to improve the premises for people using the service new floor covering was being fitted in a bathroom, toilet and the hair salon during this visit. The grounds and gardens were well kept and accessible to people using the service if they wished to sit outside when the weather permitted. All the laundry was done at the home. A suitable equipped laundry room ensures clothes are washed promptly and returned to people using the service. Gloves and plastic aprons were available throughout the home for members of staff to use in order to protect themselves and people using the service from infection. Care Homes for Older People Page 20 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Members of staff are encouraged to acquire the skills and knowledge necessary in order to meet the needs of people using the service. Evidence: The duty rota provided details about the grades and number of staff on duty for each shift. Five members of staff completed the survey and in answer to the question are there enough staff on duty to meet the individual needs of all the people who use the service one stated always, one usually and three sometimes. However, there was no evidence to suggest that the needs of people using the service were not being met. The relative of one person said there was always staff about when they visited. We looked at the files of three members of staff appointed since the last inspection. These files indicated that all the required information had been obtained before these members of staff had started working at the home. These included two written references and a Criminal Records Bureau check. However, the manager was advised not to accept references from friends and where possible to obtain at least one from a previous employer. These checks ensure people who use the service are protected from the employment of unsuitable staff. Discussion with the manager and members of staff confirmed that training was actively encouraged. This included induction training for new employees, moving and Care Homes for Older People Page 21 of 29 Evidence: handling, basic food hygiene, first aid, safeguarding, palliative care, challenging behaviour, infection control, fire and dementia. In addition to this most of the care workers had National Vocational Qualifications at level 2 or 3 in health and social care and the two senior care workers had level 4. Care Homes for Older People Page 22 of 29 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. The views of people using the service are considered when decisions about the care and facilities provided at the home are made. Evidence: The manager is an a qualified nurse with experience of caring for people suffering from dementia and mental health problems. She keeps up to date with current practice by attending relevant seminars, reading care journals and using the internet. One member of staff interviewed during this visit said the manager was approachable and supportive. Discussion with the manager confirmed that she was committed to running the home in the best interests of the people living there and had achieved the nationally accredited Investors in People Award. The people using the service and their relatives were asked to give their views about the home by completing anonymous satisfaction questionnaires every year. The last one was done in April this year and a chart was available explaining peoples responses, which were mainly positive. Meetings with Care Homes for Older People Page 23 of 29 Evidence: people using the service were held regularly to enable them to discuss any aspect of their life at the home. The Annual Quality Assurance Assessment stated that as a result of listening to the views of people using the service they are planning to increase the range of leisure activities provided. Several people using the service had a small amount of money kept at the home to pay for hairdressing, chiropody and other personal needs. To ensure this was managed safely records of all transactions were kept. We checked one of these during the visit and found the records to be up to date and accurate. Policies and procedures for safe working practices were in place. These help to make sure the home is a safe place to live and work. We looked at the records of the weekly testing of the fire alarms. Although the manager said that emergency lighting was checked monthly there were no records available to support this. The manager was advised to ensure that a record of these checks were made. However, both the emergency lighting and the fire alarm system had been serviced by an outside engineer in May this year. Fire drills were held regularly and an up to date fire risk assessment was in place. We looked at the records of routine servicing of equipment. These included an up to date electrical installation certificate and evidence that the testing of small electrical appliances was carried out annually. Although the gas safety certificate was out of date arrangements were in place for this to be renewed. Several days after this visit we received confirmation that a new certificate had been obtained. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 25 of 29 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 7 15 Care plans must accurately identify and address all the care needs of each person using the service. This will ensure that all the nurses and care workers will know what they need to do in order to fully meet the needs of each person using the service. 31/07/2009 2 8 13 Risk assessments for falls, 31/07/2009 nutrition and the development of pressure sores must be completed for each person using the service. This will ensure that risks are identified and effectively managed. 3 9 13 Records of medicines received into the home and given to people must be clear, accurate and complete. 31/07/2009 Care Homes for Older People Page 26 of 29 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 This will make sure all medicines can be fully accounted for. 4 9 13 Medicines must be given to 31/07/2009 people as prescribed. This is important because receiving medicines at the wrong time, wrong dose or not at all can seriously affect a persons health and wellbeing. Storerooms must be kept locked. This will prevent people using the service from being injured if they mistakenly enter these rooms. 6 22 13 Nurse calls must be accessible to people using the service in their bedrooms. This will enable people using the service to ask for help when needed. 7 26 16 The unpleasant odour in several bedrooms must be eliminated. This will ensure people using those rooms live in a homely and comfortable environment. 31/07/2009 28/08/2009 31/07/2009 5 19 13 Care Homes for Older People Page 27 of 29 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 1 7 Care plans should be reviewed monthly and any changes to the care required should be written in that persons individual care plan. Procedures and paperwork used to support people that look after their own medicines should be reviewed to help make sure their medicines are handled safely. To ensure people using the service are protected from the employment of unsuitable staff references should not be requested from friends of the applicant. 2 9 3 29 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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. 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