Inspection on 06/11/08 for Marley Court Nursing & Residential Home

This inspection was carried out on 6th November 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Marley Court Nursing &... 13/10/09

Marley Court Nursing &... 15/04/08

Marley Court Nursing &... 16/07/07

Marley Court Nursing &... 27/02/06

Marley Court Nursing &... 12/10/05

Marley Court Nursing &... 17/01/05

Marley Court Nursing &... 17/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Marley Court Nursing & Residential Home Bolton Road Heath Charnock Chorley Lancashire PR7 4AZ     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: Susan Hargreaves     Date: 0 6 1 1 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 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 29 Information about the care home Name of care home: Address: Marley Court Nursing & Residential Home Bolton Road Heath Charnock Chorley Lancashire PR7 4AZ 01257226700 01257234407 marleycourtnh@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Marley Court Nursing Home Limited care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with 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: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 49 Date of last inspection Brief description of the care home Marley Court is a purpose built home, which is registered to provide both personal and nursing care for older people. The accommodation at Marley Court is offered on two floors, the first floor being accessed by stairs or passenger lift. There are a range of single rooms some with en suite facilities and double or companion rooms, some of which also have en suite facilities. There are two lounge/dining rooms, one on each floor and a range of toilet and bathing facilities throughout, there is also a fully equipped laundry. There is a large patio area at the front, furnished with hardwood garden furniture and set around a central fountain. This area, along with the side gardens is fully accessible to residents, regardless of mobility. As Marley Court is Care Homes for Older People Page 4 of 29 0 Over 65 49 Brief description of the care home situated on the main A6 road from Chorley to Adlington it is well provided by public transport. The current fees charged at Marley Court are £412 to £533 per week. Additional charges are payable for hairdressing, newspapers, chiropody and toiletries. A statement of purpose and service user guide was available to prospective residents 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 unannounced inspection, which included a visit to the home, was conducted at Marley Court on 6 November 2008. Since the last key inspection of 15 April 2008 a random inspection was carried out on 20 August 2008 to monitor compliance with the requirements made at that key inspection and because a number of safeguarding allegations had been made. Following this inspection statutory enforcement notices were issued to make sure care plans were reviewed and kept up to date and provided detailed information about the health and social care needs of each person using the service. Compliance with these notices was checked at this inspection. Ten completed surveys were received from people who use the service. Care Homes for Older People Page 6 of 29 At the time of this inspection forty four people were living at the home. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty, people who use the service and visitors were spoken to. Discussions also took place with the acting manager regarding issues raised during the inspection. A specialist pharmacist inspector looked at all aspects of the management of medication because previous inspections had found shortfalls. What the care home does well: What has improved since the last inspection? What they could do better: Prompt action must be taken to make sure care plans accurately identify and address all the care needs of people who use the service. It is also important that health related risks are identified so that a care plan can be developed about how these risks are to be managed. A risk assessment for the development of pressure sores must be completed for all people who use the service. When care plans are reviewed for their effectiveness any changes should be recorded in the care plan. Improvements in the communication system between nurses and care workers should be made so that care workers are aware of all the needs of the people they are looking after and can provide person centred care. Medicines must be given to people correctly because receiving medicines at the wrong dose or wrong time can seriously affect their health and wellbeing. Care Homes for Older People Page 8 of 29 There should be an effective system in place to check medicines and staff competence to make sure medicines are handled safely. Suitable arrangements for the disposal of medicines must be made to make sure they are kept safe and not mishandled. To make sure people who use the service receive person centred care their preferred daily routine including the time they like to get up and go to bed should be written in their individual care plans. The acting manager should ensure systems are in place to make sure medication is managed correctly and people using the service receive person centred care. 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 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 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 sufficient information was obtained in order to identify the needs of each person using the service. 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 acting manager visited people who were considering using the service in hospital or their own home prior to admission. The purpose of this visit is to assess the persons health and personal care needs in order to ensure they can be met at the home. The care records of a person recently admitted to the home included a pre-admission Care Homes for Older People Page 11 of 29 Evidence: assessment. This assessment provided information for the development of the care plan. Seven people who use the service completed a survey and all of them indicated that they had received enough information about Marley Court to enable them to decide they wanted to live there. Standard 6 is not applicable to this service. 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. Privacy and dignity was promoted for people who use the service but they do not always receive person centred care. Deficiencies in the management of medication could put people who use the service at risk. Evidence: The individual care plans of five people who use the service were inspected. These plans did not identify all the health and personal care needs of each person or give clear guidance for staff to follow in order to make sure they received person centered care. The care plans were reviewed monthly but any changes to care were usually recorded in the evaluation instead of the care plans themselves. The care plan for a person recently admitted to the home stated that exercises should be attempted daily without any indication of what these involved or why they were necessary. This person also had a pressure sore but a risk assessment for the development of pressure sores was not in place. Neither was there a care plan with clear guidance for staff to follow about what they needed to do to relieve pressure for Care Homes for Older People Page 13 of 29 Evidence: this person in order to promote healing and prevent the formation of further pressure sores. Although a wound care assessment form had been completed about this pressure sore the size of the sore was not recorded. Nurses were advised to change the dressing twice weekly but the days on which this should be done was not stated. However, dressing changes were recorded on a wound evaluation chart and indicated this was done every two or three days. Four of the people whose care records were inspected did not usually get out of their beds for any period during the day and it was hard to identify the reasons for this except maybe the presence of pressure area problems. In the case of one person their pressure area problems might have been lessened by periods when their feet were not resting on the bed. Moving and handling assessments did not give members of staff the information about the size of slings to be used to ensure people using the service were moved safely. Although members of staff appeared to treat people with respect it was clear in a few instances that they were not giving the care planned and there were times when communication between the care workers and registered nurses was not sufficient to ensure important information was shared. The care of one person using the service was discussed with two care workers, one was unaware the person had a pressure sore, the other thought there was a pressure sore but did not know if it had cleared up. The daily record of care was completed by registered nurses although the majority of the hands on care was delivered by the care workers. It was not clear how the information was shared prior to this and good practice would indicate that care records be completed by the person delivering the care. There did not appear to be any difference in the delivery of care to people assessed as needing nursing care and those assessed as needing pesonal care only. The registered nurse in charge on each floor of the home was responsible for recording all the care delivered. All five people indicated they were happy with the care they were getting and that staff treated them well. Discussion with the relative of a person using the service confirmed that the care provided had improved over the last few weeks. Three of the people who use the service who completed surveys also commented on recent improvements in the standard of care. As part of the visit a specialist pharmacist inspector looked at how medicines were Care Homes for Older People Page 14 of 29 Evidence: being handled because previous inspections had found shortfalls. We observed part of the morning medicines round and checked the medicines stocks and records of a sample of people who lived in the home. We checked the records of medicines received into the home, given to people and disposed of and found they were usually signed and up to date. However we found several mistakes that raised concerns about the general competence of some of the staff. Two different people had their pain relief medicines given late on several occasions because nursing staff had failed to follow the doctors instructions. The acting manager and the nurse on duty both agreed that the times to give these medicines had been calculated wrongly. Giving medicines at the wrong time can seriously affect a persons health and wellbeing and for these people it could have caused unnecessary pain. We looked at a sample of care plans and records to find information about how medicines were to be given. Care plans for two diabetic people were detailed and had enough information to make sure their blood sugars were properly checked and up to date information about the correct dose of insulin. A person suffering with severe pain had a detailed care plan about how this was to be managed and this had been accurately updated everytime a dose was changed or a new medicine was prescribed. Having clear written plans helps make sure people get their medicines when they need them. We checked how controlled drugs (medicines that can be misused) were handled. A suitable secure cupboard was used for storage and a special register was used for record keeping. All stock was double checked at the begining of each shift by two nurses to make sure they were correct. However, on the day of the visit some currently prescribed controlled drugs were found in a container normally used for the disposal of medicines and not in the controlled drug cupboard. Controlled drugs should be stored securely at all times to help prevent them being misused. We looked at how medicines were stored and found the fridge was too cold and had been for at least six weeks but staff had done nothing about it. We also found some medicines wrongly kept in the fridge instead of at room temperature. Keeping medicines at the wrong temperature can spoil them, which could affect the health and wellbeing of the person taking them. We looked at the arrangements for the disposal of medicines because previous inspections had raised concerns about their security and the way they were recorded. On the day of the visit some medicines, including controlled drugs, were insecurley stored and two tubes of cream had been disposed of but no record had been made. Care Homes for Older People Page 15 of 29 Evidence: Poor practice when disposing of medicines can lead to them being misused or mishandled. We looked at how medicines were checked and audited. We saw evidence of monthly checks and these had found some mistakes that had been acted upon to help prevent them happening again. However, our checks found further mistakes that seriously question the competence of some staff. The manager said that no system of formally checking staff competence was in place although some medicines handling training had been recently provided by the community pharmacist. Competency checks on staff help make sure they have the necessary skills to handle medicines safely. Care Homes for Older People Page 16 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. Social activities and meals are well managed and provide daily variation and interest for people living at the home. Evidence: An activities co-coordinator has recently been employed and is responsible for organising a range of leisure activities and social events suitable for people using the service. Discussion with the activities co-coordinator confirmed that in consultation with people using the service she was developing a programme of activities. These included, armchair exercises, crafts, bingo, puzzles, manicures, sing alongs, films, card games and snakes and ladders. In addition to this special occasions were celebrated and people using the service had made decorations for Halloween. The activities cocoordinator said she visited all the people using the service in the morning and invited them to attend the activity organised for the afternoon. Each morning she also spent time individually with people who preferred to remain in their own rooms and were unable or didnt want to join in group activities. Several people who use the service were observed enjoying a game of bingo during the afternoon on the day of this inspection. Care Homes for Older People Page 17 of 29 Evidence: Regular contact for people using the service with their family and friends was considered to be an important part of their life. People said their visitors were welcomed into the home at anytime. The daily routine was discussed with two members of staff and the acting manager. They explained that some people were assisted to get up by the night staff from 7am onwards and several other people who liked to get up early were able to do so without assistance from staff. The acting manager explained that the small number of people who had been washed and dressed and left in bed were those who were unable to get up or chose to remain in bed. To ensure people using the service receive person centred care the preferred daily routine including the times they liked to get up and go to bed should be recorded in their individual care plans. The meal served at lunchtime looked wholesome and appetising. Lunch was unhurried allowing people time to chat and enjoy their meal. Blended meals were served with each item of food blended separately so people could identify the and experience the individual flavours. Members of staff were observed assisting people to eat their lunch in a patient and caring manner. All the people using the service who were asked said the meals were good. Care Homes for Older People Page 18 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. People who use the service knew how to express their concerns. Members of staff had a good understanding of safeguarding issues. Evidence: A copy of the complaints procedure was displayed in the home and included in the service user guide. Nine people who use the service who completed a survey indicated that they knew how to make a complaint. The acting manager said no complaints had been made since the random inspection of 20 August 2008. No complaints have been made directly to the Commission. Policies and procedures about the safeguarding of vulnerable adults were in place. Discussion with two members of staff confirmed they had received training in safeguarding vulnerable adults. They also knew what to do if allegations of abuse were made. However, two allegations of poor care practice have been made since the random inspection. These have been investigated by social services and the manager has taken action to improve care practice. The relatives of one person who used the service said that care had improved. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises were well maintained and provided a comfortable and homely environment for people who use the service. Evidence: A tour of the premises confirmed that the home was clean and tidy and the carpets in the stairs, corridors and bedrooms which were dirty at the last inspection had been cleaned. This provided a safe and comfortable environment for people who use the service. Several bedrooms had also been redecorated and the handyman said he was developing a rolling porgramme of redecoration to ensure the present standard was maintained. People who use the service were encouraged to bring personal items for their bedrooms to make them more homely. These included ornaments, photographs and pictures for the walls. One person who used the service wrote on their survey, over recent weeks there has been a very big improvement in the overall cleanliness of the home. The grounds and gardens were well kept and accessible to people who use the service if they wished to sit outside when the weather permitted. All the laundry was done at the home. A suitably equipped laundry room ensured Care Homes for Older People Page 20 of 29 Evidence: clothes were washed promptly and returned to the people using the service. Gloves and plastic aprons were available for members of staff to use in order to protect them and the people using the service from infection. Care Homes for Older People Page 21 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. The people who live at the home are supported by well trained, effective staff who have gone through a thorough recruitment process, so their needs are met ant they are safe from possible harm or poor practice. Evidence: The duty rota provided information about the grades and numbers of staff on duty for each shift. Staffing levels have increased since the last inspection and throughout the day there is one nurse and four care workers on duty on both floors of the home. This makes sure there is sufficient staff on duty in order to meet the needs of the people who use the service. Although one member of staff and the acting manager said that staff absence continued to cause some problems agency staff were employed to cover any shortfalls and it was unusual for the home to be short staffed. Ten people who use the service completed a survey and in answer to the question are the staff available when you need them, one person indicated always, eight usually and one sometimes. One person wrote on the survey over recent weeks it has been noted that there are more staff visible and available. The acting manager explained that no new staff had been appointed since the last inspection. However, she had interviewed a number of applicants and was waiting for Care Homes for Older People Page 22 of 29 Evidence: Criminal Records Bureau checks to be completed before any of them would be allowed to start working at the home. These checks ensure people who use the service are protected from the employment of unsuitable staff. Discussion with the acting manager and members of staff confirmed that training was encouraged. This included induction training for new employees, moving and handling, management of medication, safeguarding vulnerable adults, dementia care and fire safety. In addition to this thirteen care workers have National Vocational Qualifications at NVQ level 2 or above in health and social care. This is a recognised qualification for people working in the care profession. Care Homes for Older People Page 23 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 adequate 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 who use the service were considered when decisions about the care and facilities provided were made. Management arrangements do not ensure people using the service receive person centred care. Evidence: The acting manager has only been in post for a few weeks and has begun to make changes in order to improve the standard of care provided at the home. She is an experienced nurse and manager and has the NVQ registered managers award. Members of staff said she was approachable, listened to them and was good with the people who use the service. However, management systems were not in place to ensure that care plans provided sufficient detailed information to ensure people who use the service received person centred care. It is also the responsibility of management to ensure medication is managed correctly and that members of staff responsible for the administration of medication are competent. Care Homes for Older People Page 24 of 29 Evidence: It was evident that the management were committed to quality assurance and had obtained the nationally accredited Investors in People award. People who use the service were asked to complete questionnaires in October. When these were returned the acting manager said she would identify areas for improvement and develop an action plan which would then be discussed at a staff meeting and implemented. The acting manager had also held a cheese and wine party for people who use the service and their relatives and members of staff to introduce herself and chat to people about the care and facilities provided at the home. Policies and procedures for safe working practices were in place. These help to make sure the home is a safe place for people who use the service to live. Fire alarms and emergency lighting were tested regularly and an up to date fire risk assessment was in place. records of the routine servicing of equipment were seen. These included an up to date gas safety certificate and evidence that the testing of small electrical appliances was being carried out. The electrical installation certificate was due for renewal and arrangements had been made for this to be done. Care Homes for Older People Page 25 of 29 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 9 13(2) Suitable arrangements for the disposal of medicines must be made to make sure they are kept safe and not mishandled. 28/09/2008 2 9 24(1) There should be an effective system in place to check medicines and staff competence to help make sure people who live in the home are kept safe. 28/09/2008 Care Homes for Older People Page 26 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 12 Care plans must accurately 05/01/2009 identify the health and social care needs of each person using the service and provide clear guidance for staff to follow. This will make sure the health and social care needs of people who use the service are met and they receive person centred care. 2 8 12 Risk assessments for the 02/01/2009 development of pressure sores must be completed for all people who use the service. This will make sure that correct action is taken to help prevent the formation of pressure sores. 3 9 13 Suitable arrangements for the disposal of medicines must be made. 19/12/2008 Care Homes for Older People Page 27 of 29 This will make sure they are kept safe and not mishandled. 4 9 24 There should be an effective system in place to check medicines and staff competence. This will help to make sure people who live in the home are kept safe. 5 9 13 Medicines must be given to people as prescribed. Recieving medicines at the wrong dose, the wrong time or not at all can seriously affect a persons health and wellbeing. 19/12/2008 02/01/2009 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 1 7 When care plans are evaluated any changes to the care required should be written in that persons individual care plan. A more effective system of communicating information about the needs of people who use the service should be put in place to make sure care workers are aware of the needs of all the people they are looking after. To make sure people who use the service receive person centred care their preferred daily routine should be recorded in their individual care plans. This should include the time they like to get up and go to bed. It is strongly recommended that management systems are put in place to make sure all the people using the service receive person centred care. 2 8 3 12 4 31 Care Homes for Older People Page 28 of 29 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 © (2008) 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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