Inspection on 02/03/06 for Milford Manor

This inspection was carried out on 2nd March 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Milford Manor 21/01/09

Milford Manor 26/01/07

Milford Manor 08/09/05

Milford Manor 03/02/05

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Milford Manor Milford Manor Gardens Salisbury Wiltshire SP1 2RN Lead Inspector Ms Sally Walker Unannounced Inspection 09:45 2 March 2006 nd X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Milford Manor Address Milford Manor Gardens Salisbury Wiltshire SP1 2RN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01722 338652 Wessex Care Ltd Tracey Elizabeth Morris Care Home 29 Category(ies) of Dementia (29), Dementia - over 65 years of age registration, with number (29), Old age, not falling within any other of places category (29), Physical disability (1) Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may admit people to the home over the age of 60 years of age providing their assessed needs are similar to those of an Older Person. 8th September 2005 Date of last inspection Brief Description of the Service: Milford Manor is an established home that provides care and accommodation for up to 29 older people, some of whom may also have dementia. All residents have single bedrooms; both double bedrooms currently are single occupancy only. There are several communal rooms. The home has a conservatory overlooking a large garden and car parking is available to the front of the building. Milford Manor is situated in a quiet residential area of Salisbury with public transport available into the city centre. The home changed ownership in November 2004 and Mr and Mrs Airey have made great efforts to improve the environment, staffing and recording systems. They also own 2 nursing homes in Wiltshire. Mrs Tracy Morris was registered as the manager in September 2005. Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.45am and 3.30pm. Mrs Tracy Morris was present during the inspection. As the staffing records and records of monies held on residents’ behalf were kept at Wessex Care central office, the inspector inspected them on 14th March 2006 with Mrs Penny Perry, Wessex Care administrator between 9.30am and 12.15pm. During this time the inspector also spoke with Mr and Mrs Airey about their development plans for the home. At the unannounced inspection the inspector spoke with 5 residents and 2 relatives, inspected the care plans, staff training files and the daily records. A tour of the building was also made. What the service does well: What has improved since the last inspection? The home’s Statement of Purpose had been updated to reflect the current provision. Mr and Mrs Airey continue to improvement the decoration of the environment for residents’ comfort with redecoration of all the bathrooms, improvements to individual rooms and further plans for the replacement of bathrooms and upgrading the garden. The comments section of the care plans gave a better picture of residents and how their care needs were to be met. Monies held on residents’ behalf are held in the home rather than the business account. Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 6 Care staff now respect residents’ rights to their private space by knocking on doors and waiting to be invited in. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 The home provides prospective residents with a good range of information about the services and facilities provided. The home makes comprehensive assessments of potential residents to ensure that they can meet their needs. EVIDENCE: The requirement that the Statement of Purpose was reviewed again and further amended to include the new manager and that the name of a previous Commission manager was deleted was later seen to be actioned. However, on the first day of the inspection, the home still had copies of the old documents on display. Mrs Perry, the administrator, explained her process of ensuring that both prospective residents and those who had chosen to live at the home, or their families, were given other information about what they could expect from the home and what the fees provided for. Mrs Perry also provided much information about local services and facilities. Those residents recently admitted to the home had had a detailed preadmission assessment either by Mrs Morris or Mrs Airey. The format allowed for all aspects of potential residents care needs to be assessed and show good detail. Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Care plans focussed on health and personal care but there were improvements in recording more positive outcomes in the comments section. As a consequence the home had good evidence that residents health care needs were fully met. Systems were in place to ensure that residents received their medication at the times and dosage for which they were prescribed. Staff now respected residents’ privacy and personal space. EVIDENCE: The requirement that the care plans were updated to include all identified needs and how they were to be met was in good progress. The requirement that staff record interventions with residents particularly with regard to communication and fluid intake had been actioned in regard to fluid intake. The care plans showed that all aspects of residents needs were regularly assessed and there was some guidance to staff on how they should be working with each resident. However the format was a medical model and highlighted any medical diagnosis, assessment of need was entitled ‘problem’ and focussed on what residents could not do rather than promoting the positive aspects of residents care needs. The comments section gave a more positive view of outcomes for residents and discussions were held with Mrs Morris on how this section of the plans could be developed, particularly with regard to communication and different interventions for individuals. Mrs Airey later Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 10 talked about how the care plans could be developed to ensure they were more person centred. She talked about the social histories being requested of relatives to augment care planning with residents. The care plans identified personal hygiene, mobility, eating and drinking, continence and bowl management, sleep patterns, mouth care and cognition and emotional need. There was very little detailed guidance in the plans of what staff were expected to provide to meet the needs of each individual resident. Care plans were kept in residents’ bedrooms. The daily reports were kept in the office. Residents’ weights were regularly recorded but there was no consistency in recording in both imperial and metric so it could not easily be established whether some residents had lost or gained weight. However food supplements were available if needed. One daily report recorded that one resident had come to the dining room after a meal for something else to eat, but there was no report as to whether they were given anything. Another daily report recorded that a different resident who was hungry was regularly given sandwiches and toast. Immediate care charts were in place for recording food and fluid intake for specific residents. Risk assessments were in placing for falls and residents risk of developing pressure damage. One resident was identified as having a ‘sore on bottom’ but there was no record of size, location or whether it was being treated or progress in healing. Body maps and photographs were I place for some wound management records. One residents care plan recorded that they went out for regular walks. However there was no risk assessment in place and it was later established that this resident only went out with staff but the care plan gave a different impression. Residents had good access to healthcare professionals and any interventions were recorded on file. The requirement that staff respect residents’ personal space by knocking and waiting to be invited into bedrooms before entering had been actioned. Staff were seen to be respectful of residents private space. Those residents who were spending the morning in their bedrooms had their call bells within their reach and drinks beside them. All of the residents were well groomed with clean clothing, glasses, teeth and fingernails. Their clocks were showing the correct time. One resident said that staff would bring their medication to them with their meals. Staff were very diligent in recording good detail of prescribed medication in the daily report, particularly times of administering antibiotics to ensure that they were given as soon as they were brought from the chemist. There was good recording of where residents had refused vital medication and an action plan following consultation with the GP to ensure the resident’s health care was not compromised. The requirement that liquid medication was only given to the person for whom it was prescribed and that the supplying pharmacist should supply in smaller containers had not been actioned. The home continued to use 1 or 2 bottles for administering to all the residents who were prescribed this medication. Mrs Morris said that she had been told that this practice was satisfactory. Guidance to Mrs Morris from the Pharmacist Inspector has been given in a separate letter soon after the inspection. The Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 11 recommendation that the prescribing GP should be reminded to revise the repeat prescription form when they make and change in medication dosage to ensure that the correct dosage is then described on the medication administration record had been actioned. The recommendation that where handwritten entries were made on the medication administration record when new medication was prescribed or changed that they were witnessed signed and dated by 2 staff had been actioned. Mrs Morris was advised that the Commission must be notified of specific outbreaks of infestations or certain infections under Regulation 37 and this was received soon after the inspection. Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15 Residents could follow their own routines. A good activities programme was in place. The home encourages contact with families. Residents enjoyed the range and quality of meals. EVIDENCE: Those residents who were able followed their own routines. Some residents liked to get up in their own time and this was detailed in their care plans. The company employs a welfare co-ordinator who provides activities mainly at Milford Manor. There was also a welfare assistant supporting with trips out and other activities. Group activities and also one to one time with residents were provided. Records were kept of the activities undertaken and those residents involved. Residents said they could join in with the activities if they wanted to or stay in their room and watch television. One resident goes out shopping on their own each week. Another resident said the local library drive to the home with a selection of books. One resident said the home had regular musical events which they liked. One resident described the Christmas party. Mr Airey said a local mini bus was used to take residents out in the locality or to the theatre. The home encouraged contact with families and friends and their were regular relatives meetings. Residents said they enjoyed the meals provided with some describing their favourite foods. Where some residents had difficulties with chewing or Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 13 swallowing their meals, the individual ingredients had been liquidised to allow them to enjoy the different flavours of the food. Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Systems were in place for residents and their families to make their views know about the service and to make complaints. The local vulnerable adults procedure was in place and staff were due to be trained in using it to protect residents from abuse. EVIDENCE: The home has a complaints procedure and keeps a log of complaints. The log details the nature of each complaint together with outcome of investigations actions taken and response to the complainant. Those residents with whom the inspector could communicate were asked about making a complaint or reporting issues that they were not happy about. Most said they would talk to their family or Mrs Morris. The home had copies of the local vulnerable adults procedure for reporting allegations of abuse. Mrs Morris said that 3 staff were due to undertake training in the protection of vulnerable adults and reporting abuse later in the month. The home used a local advocacy service where needed particularly if any residents had no family to act on their behalf. Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Significant improvements have been made to the comfort of the environment for residents. Further plans intend that the gardens are re-designed and all the bathrooms and toilets replaced. Much consideration is given to ensure that any refurbishments use current guidance on working with people with dementia. The home was cleaned to a good standard and no unpleasant odours were detected. The undersides of toilet surrounds and some commodes were not regularly cleaned. EVIDENCE: All the rooms were single occupancy including those designated as doubles. Rooms had been personalised with residents bringing their own small items of furniture and personal items. Rooms were comfortable and clean with no unpleasant odours detected at any time during the inspection. The requirement that the decoration in some toilets and bathrooms was improved and that appropriate levels of hygiene were maintained at all times throughout the home with the undersides of toilet safety frames being included in the cleaning schedule was actioned in part. All the bathrooms and toilets were in good decorative order. Mrs Morris said that all of the bathrooms and Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 16 toilets would be refurbished this year with new fittings and furniture. However the toilets and bathrooms were only found to be cleaned in the areas that were visible. The undersides of toilet surrounds had brown drip marks and one commode in a room made up for a new resident had dried brown matter on the underside. Mrs Morris immediately addressed the matter with the cleaning staff. In contrast the undersides of the bath hoist seats were cleaned to a good standard and all the wheelchairs were clean and had their foot rests attached. The Health Protection Agency guidance to care homes on infection control was available in the home. Gloves, protective clothing and medicated hand washing materials were available to staff. The inspector advised that all staff involved with cleaning toilets and commodes should be trained infection control. Mr Airey later confirmed that cleaning staff were employed from 9.00am to 6.00pm seven days a week and that Mrs Morris had indeed addressed the matter with each of these staff. In the empty bedroom both the top sheet and the under sheet of the bed which was made up, were heavily stained, although appeared to have been washed. The bed was made up with a continence sheet and there was a continence cover on the easy chair in the room. This room was not allocated to a particular person, yet whoever had made the bed assumed that the occupant would have continence problems. The inspector advised that the disposable razors found in the bathrooms should not be for communal use as residents should have their own razors. One resident said they could use their commode during the day if they wanted as they could not easily get to their nearest toilet. Mr and Mrs Airey said they had consulted with the Alzheimers Society about their plans to re-design the garden for it to be more accessible to residents. They went on to say that the sitting room and dining room would also be redecorated this summer. Mr Airey said that the wash hand basins in the bedrooms were gradually being replaced with new. Mrs Airey said she had consulted with the Alzheimers Society about replacement furniture for the sitting rooms with a view to replacing it with sofas and less institutionalised seating. Advice was also given about supporting residents to negotiate the environment with photographs on bedroom doors and signs on communal rooms like toilets and bathrooms. Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Staffing levels normally support residents with achieving the aims of their care plans. Deficient staffing levels were not always reported to the Commission. Staff had good access to ongoing relevant training. Robust recruitment procedures were in place. EVIDENCE: There were 3 care staff and Mrs Morris on duty during the morning of the inspection. Mrs Morris said that one staff had phoned in sick and she had had difficulty in obtaining cover. Mrs Morris was advised that the Commission must be notified when staffing levels cannot be achieved. There were also the chef, 3 cleaners and a kitchen assistant on duty. One resident said that the staff were very busy. The employment records were kept centrally at Wessex Care’s central office. Mrs Penny Perry, the administrator, gave access to these records which showed that the home was following robust recruitment procedures, with all potential staff having to complete an application form, declare any convictions and be subject to Criminal Records Bureau checks and POVA checks, 2 references supplied, some confirmed by telephone and all the information and documents required by Schedule 2 kept on file following appointment. The home also keeps records of interviews. No new staff commenced duties without a Criminal Records Bureau certificate being applied for and a negative POVA check. Mrs Morris only kept the staff training and supervision files at the home. Mrs Morris was the company’s trained trainer in moving and handling and all staff Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 18 had regular updated training. She went on to say that the chef was the company’s trained trainer in food hygiene and kept all staff up to date in this area. Mrs Morris kept a record of which core areas of training were needing updates and each staff had individual files of their certificates of training. The local Alzheimers Society had recently commenced a series of training sessions for staff in dementia care. Staff had undertaken training in administration and control of medication and fire prevention. Mr Airey had secured a new training provider to ensure that staff undertaking NVQs could have their work assessed to complete their training following the collapse of the previous provider. All new staff are required to undertake the company’s induction training and were provided with a certificate when completed. Mrs Morris was currently inducting 2 new staff. Although male staff were employed as carers there was no policy document detailing their working arrangements for protection of residents or the male staff from allegations of any kind. Residents said the staff were friendly and kind. Two relatives said the staff were very attentive and would always update them on their relative’s progress. They said they were made very welcome in the home. Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 35 Mrs Morris had a good understanding of her role as manager of a home for people with dementia. The home is run in the best interest of the residents. Residents’ financial interest were safeguarded. EVIDENCE: Mrs Morris said that she works alongside staff and was allocated 15 hours a week for administrative duties. She also likes to keep up her nursing registration by working at least one shift each week as a nurse in either of Wessex Care’s 2 nursing homes. This is exclusive of her contracted hours to Milford Manor. The requirement that a more suitable bank account was found so that managing residents monies does not involve paying their money into the main business account had been addressed. Mrs Perry, the administrator, showed the residents cash accounts for money held in the home on residents’ behalf and explained the system. Whilst cheques from residents’ families or solicitors for their person allowances were being paid into the business account, the Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 20 account did not hold any money for residents. There was a petty cash account held at the home for residents to spend on themselves. Receipts were kept and at the end of the month the families or solicitors were invoiced for the amounts which were mainly for chiropody, hairdressing, taxis or clothing and toiletries. Small amounts of cash were held on residents’ behalf in the central safe. Mrs Perry said that the home did not manage any residents’ pensions or benefits and expected families or solicitors to deal with these if residents could not. She went on to say that Age Concern may advocate for residents who did not have relatives to manage their finances. Mrs Morris said that she had an amount of money which residents could draw on if needed and this would be repaid from the central office or family invoiced if no money was held on the resident’s behalf. Records of these transactions were well documented. The home offers 3 monthly meetings with residents and their relatives to discuss any issues. Mrs Morris said that the local Alzheimers Society came to the last meeting to talk to relatives about the condition and to discuss any issues. Minutes of the meetings were displayed in the entrance hall. Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X X Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Timescale for action 01/09/06 2. OP26 23(2)(d) 3. OP9 13(2) 4 OP27OP8 37 The person registered must ensure that care plans reflect all of the residents’ individual need not just the medical or physical. Consideration should be given to positive outcomes for residents with a more person centred approach. (This will involve developing a different format so more time has been given). The registered person must 01/05/06 ensure that cleaning staff are trained in infection control to maintain proper levels of hygiene are maintained at all times throughout the home. The undersides of toilet safety frames and commodes must be included in cleaning schedules. The person registered must 02/03/06 ensure that liquid medication is only given to the person for whom it is prescribed. The pharmacist may supply in smaller containers. The person registered must 02/03/06 ensure that the Commission is notified without delay of incidents specified in Regulation DS0000062170.V278739.R01.S.doc Version 5.1 Milford Manor Page 23 37, particularly when staffing levels cannot be achieved or infections noted. 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. 2. Refer to Standard OP9 OP9 Good Practice Recommendations The person registered should ask the GP to revise repeat prescriptions when they make a change in medication dosage. The person registered should make sure that when handwritten entries are made on the medication administration record when new medication is prescribed or there is a change in medication that these entries are witnessed, signed and dated by 2 members of staff. Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Milford Manor DS0000062170.V278739.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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