Inspection on 01/08/08 for Milton Lodge

This inspection was carried out on 1st August 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Milton Lodge 04/02/09

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Milton Lodge 32 Milton Road Bournemouth Dorset BH8 8LP Lead Inspector Gloria Ashwell Key Unannounced Inspection 1st August 2008 11:30 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 Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 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. Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton Lodge Address 32 Milton Road Bournemouth Dorset BH8 8LP 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) 01202 556873 01202 316881 Kensington Care Ltd Mrs Frut Mary Haworth Care Home 18 Category(ies) of Dementia (18), Old age, not falling within any registration, with number other category (18) of places Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) 2. Dementia (Code DE) The maximum number of service users who can be accommodated is 18. New service Date of last inspection Brief Description of the Service: Milton Lodge is a long established care home catering for older people including those with dementia. It is a traditionally built detached house, with gardens to front and rear. Car parking is unrestricted on the road outside the home. Resident accommodation is on the ground and first floor; a lounge, sun lounge and dining room are on the ground floor. A stair lift is installed on the longest flight of steps on the main staircase but it is then necessary to negotiate an additional flight of stairs to gain access to the first floor and to reach some bedrooms it is necessary to descend additional steps; residents whose bedrooms are upstairs must therefore be able to independently manage steps. All bedrooms have a wash hand basin; one has separate en suite hygiene facilities and all are close to a toilet. With the exception of one bedroom for shared use by 2 persons, all bedrooms are for single occupancy. There is one bathroom for use by persons requiring assistance; the bath is fitted with an elevating bath seat but the bathroom is not large so suited only for use by persons who require low levels of assistance. Fees are charged weekly; the fee range quoted by the manager at the time of Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 5 inspection was (per person) from £530. Up to date information on fees can be obtained from the service. Information regarding the subjects Value for Money and Fair Terms in Contracts can be obtained from the web link: www.oft.gov.uk A report entitled Care Homes in the UK - A Market Study is available on web link http:/www.oft.gov.uk/NR/rdonlyres/5362CA9D-764D-4636-A4B1A65A7AFD347B/0/oft780.pdf Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is Zero star. This means the people who use this service experience poor quality outcomes. This was a statutory inspection required in accordance with the Care Standards Act 2000 and was the first inspection to have been carried out since the service was registered to the provider organisation during May 2008. This inspection was unannounced; the inspector arrived at 11:30 on 1 August 2008, toured the premises and spoke to residents, staff, observed staff interaction with residents and the carrying out of routine tasks and together with registered manager Mrs Haworth discussed and examined documents regarding care provision and management of the home. The duration of the inspection was 3 hours. During the inspection, particular residents were ‘case tracked’; for example, for evidence regarding Standards 3, 7 and 8, records relating to the same residents were examined and the residents spoken with. In advance of the inspection an Annual Quality Assurance Questionnaire was completed by Mrs Haworth and returned to the Commission; the information it contained has been used to inform the findings of this inspection. During this inspection compliance with all key standards of the National Minimum Standards was assessed. An Immediate Requirement relating to the safe handling of medicines was issued during the inspection. What the service does well: Milton Lodge meets residents’ expectations, provides access to health care professionals and staff treat residents with respect and kindness. Contact with family and friends is promoted and there are good links within the local community. Meals are home cooked with a range of fresh produce and a good selection of fruit and sweets available. Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 7 Time is taken to support individual residents and staff were observed throughout the inspection to be treating residents with courtesy, patience and kindness. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 8 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 Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (The home does not provide intermediate care so St 6 does not apply) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prior to admission, the needs of each proposed resident are assessed to ensure the home will be properly able to meet them. EVIDENCE: The records of three recently admitted residents included details of preadmission assessments carried out by the manager or previous owner when they visited the prospective residents at their then addresses. In advance of making the decision to enter the home the closest relatives of the prospective residents visited Milton Lodge to view the premises and meet residents and staff. Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 10 Following pre-admission assessment of each prospective residents needs and circumstances the home writes to them confirming the agreement and ability to provide accommodation and care. To ensure prospective residents have sufficient information upon which to base their decision to enter the home it is recommended that the fee range be specified in the service user guide. Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents receive the care they need and the medicines they have been prescribed but associated records require improvement to ensure staff have sufficient guidance to enable them to properly care for the residents and to protect them from the harm and ill health that incorrect administration might cause. EVIDENCE: Comments received by the Commission in advance of the inspection from health care professionals indicated satisfaction e.g. “Friendly atmosphere, very professional” and comments made by residents during the inspection were also good. Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 12 Care records of 3 residents were examined and found to be of generally poor standard, frequently without relevant risk assessments forming the basis for care plans, thereby rendering the plans unreliable and not reflective of separately recorded descriptions of condition of each person. The failure to provide adequate plans of care for these residents placed them at risk of poor and inappropriate care because their needs and circumstances had not been fully assessed and thereby were not recorded in the care plans, and may not be known to staff. For example, records of body weight indicated that two of the residents had recently lost weight but no reference to these circumstances were made in any record including the care plans; records of food intake were incomprehensible, the home does not use an established ratings tool to assess the nutritional or skin care conditions of residents and the care plans of these persons did not indicate that consideration had been afforded to the potential for specific nutritional attention. There was insufficient evidence that all accidents to residents are thoroughly investigated with findings reflected in the care plan, to ensure that future risks are minimised. It is required that for each resident the home record an accurate and comprehensive care plan and associated records ensuring provision of sufficient information to staff enabling them to properly care for and safeguard every resident. For medicine handling the home uses a monitored dosage system, whereby most of the medications are stored in blister packs, to simplify the process of administration. Staff trained in this work carry out all medicine handling; none of the currently accommodated residents manage their own medicines. From examination of a sample of Medication Administration Records (MARs) and discussion with the Registered Manager there was evidence that in general they were poorly kept; there were many occasions of prescribed medicines not having been signed for to confirm administration during recent days, and one occasion of a medicine signed in advance of administration i.e. for the date of inspection the 17.00 dose of Donezepil prescribed for one resident was signed for to confirm administration, before 11:30 on that date. An Immediate Requirement was issued during the inspection to ensure that an accurate record of each instance of medicine administration be kept for each resident. To ensure there is a clear audit trail, when a variable dose is prescribed (e.g. “give 1 or 2 tablets”) the amount actually administered on each occasion must be recorded. The practise of obliterating erroneous entries in MARs and care records by the use of correcting fluid, or over-sticking strips of paper, must cease; incorrect entries should be crossed through, rewritten and signed and dated by the person making the entry. Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 13 Medicines are stored in a wooden cabinet in the office; it is recommended that the maximum/minimum temperatures of this area are monitored and recorded daily to ensure that medicines are not damaged by incorrect storage. In case of need, the home must have available suitable storage for Controlled Drugs; at the time of the inspection the manager thought the home did not have a Controlled Drugs register but after the inspection notified the inspector that a register had been found. In accordance with good practice it is recommended that the administration of Temazepam, currently prescribed for 2 residents, be in accordance with Controlled Drugs methodology. At the time of the inspection containers of eye drops were kept in the kitchen fridge in a plastic food container; after the inspection the manager notified the inspector that a suitable lockable container had been found. To further improve medicine handling processes it is recommended that when an ‘as required’ medicine is prescribed, the reason for administration (e.g. leg pains) be recorded on the MAR instructions, that all handwritten MAR instructions be signed and dated by the author and countersigned by a person who has checked the accuracy of the record, and that each MAR bears an allergy statement about the particular reference e.g. ’ Allergies? None known’ or ‘Allergic to Penicillin’. In the presence of staff residents appeared relaxed, confident and at ease; staff interactions with residents were of a friendly and considerate manner and the atmosphere throughout the home was calm and unhurried. Residents are treated with respect but more should be done to ensure that good practice is observed at all times; e.g. during lunch in the dining room a carer was seen standing over the resident she was feeding with a soft diet. The inspector drew this to the attention of the manager who had appeared unaware of the ‘good practice’ of the carer sitting with the person being fed; the manager then promptly spoke to carer and seated her. Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have opportunities to engage in social and recreational activities. Residents are encouraged and supported to pass the time according to individual preference. A choice of menu is provided and meals are nutritional and appetising. EVIDENCE: One-to-one and small group social and recreational activities are arranged in accordance with residents’ preferences; parties and dancing are popular with the residents. Residents pass the time as they wish; some spend most days in their private bedrooms, others choose to use the lounge and sun lounge. Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 15 Comments received by the Commission in advance of the inspection from health care professionals indicated satisfaction e.g. one stated the home was very good at “putting the residents at the heart of all activities” and another stated “I would be happy to place my own relatives in this home”. Visitors are welcome at any time. Residents believe they are shown respect and properly treated; comments made during the inspection included “I’m quite content”. During the inspection lunch was served to residents in the dining room and in bedrooms; residents enjoy the food and consider it plentiful and of good standard. Snacks and beverages are continuously available. Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People know how to complain and are confident their complaints are listened to. Service users are safeguarded against risks of abuse in its various forms. EVIDENCE: Residents know how to complain and feel confident that if they had concerns or complaints they will be listened to and taken seriously. The home has a complaints policy and procedure; one complaint has been received since registration to the current provider – investigation by Social Services did not uphold the complaint. There have been no allegations or investigations regarding the ‘safeguarding of vulnerable adults’. To ensure residents and their representatives have access to the complaints procedure it is included in the service user guide to the home and a copy is provided to each resident. Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean and comfortable and meets the expectations of the people who live there. EVIDENCE: Milton Lodge is a traditionally built detached house, with gardens to front and rear. Car parking is unrestricted on the road outside the home. The home is decorated and furnished in a homely and comfortable way. On the day of inspection the home was clean and tidy throughout; there were no unpleasant odours. Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 18 Bedrooms seen during the inspection were decorated to an acceptable standard. All bedrooms have a wash hand basin; one has separate en suite hygiene facilities and all are close to a toilet. With the exception of one bedroom for shared use by 2 persons, all bedrooms are for single occupancy. A stair lift is installed to the longest flight of steps on the main staircase but it is then necessary to negotiate an additional flight of stairs to gain access to the first floor and to reach some bedrooms it is necessary to descend additional steps; residents whose bedrooms are upstairs must therefore be able to independently manage steps. There is one bathroom for use by persons requiring assistance; the bath is fitted with an elevating bath seat but the bathroom is not large so suited only for use by persons who require low levels of assistance. Residents can bring items of their own furniture and belongings to keep in their bedrooms, in accordance with the agreement and safety/suitability checks of the home. All laundry is carried out on the premises using a machine that will wash to high temperatures, has a sluicing facility and complies with the “Water Supply Fittings Regulations 1999”. Drying is done outside or in a drying room. Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home employs enough staff to meet the needs of residents and to ensure their safety and comfort, and the maintenance of the premises but must improve aspects of recruitment practice. The home promotes the achievement of nationally recognised care qualifications. EVIDENCE: The home is at all times in the charge of an experienced person and staffing levels are provided in accordance with the assessed needs of residents to ensure that at all times sufficient staff are available to properly meet their needs. The records of 2 recently employed care staff were examined. The records for one of these persons contained all essential information including written references, interview assessment, health details and evidence of identity. A Criminal Records Bureau (CRB) disclosure had been obtained in advance of employment. It was noted that both written references were undated; it is Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 20 recommended that the reference request form be amended to include the date on which it is written by the referee. For the other member of staff one of the two written references was undated, and there was evidence that the person had commenced work in the home 2 weeks before the Protection of Vulnerable Adults (POVA) disclosure was obtained, 6 weeks before the CRB disclosure was obtained and before the dated reference had been written. This report contains a related requirement. The manager said that most of the care staff currently employed by the home hold a National Vocational Qualification (NVQ) in care and others are training for the award. There was evidence that recently employed staff had received induction training and that staff are encouraged and supported to undertake training in subjects relevant to their work. Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. In general, the home is properly managed but more must be done to ensure it operates in the best interests of service users and protects them from risks of harm, in particular recruitment practices do not ensure the protection of residents from potentially unsuitable staff. EVIDENCE: Mrs Haworth is the Registered Manager and has been in the employ of the home for approx. one year, having been engaged by the previous owner. Mrs Haworth holds qualifications in management and care and is able to demonstrate that she keeps up to date with training. She is supported by a Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 22 deputy manager and a team of care and household staff. The home has recently sent out questionnaires to health and social care professionals to assist the home assess the quality of the service they provide. The response has been very positive with good comments being made about all aspects of the service but quality assurance monitoring has not been implemented as a core management tool; this report contains an associated recommendation. The manager said that a representative of the provider organisation visits the home regularly, and showed the form completed on the day before the inspection when the Responsible Individual had conducted her formal supervision. The provider maintains reports of his monthly visits as required by regulation; it is recommended that these are either kept in the home or periodically forwarded directly to the Commission to ensure this information is available to inform future inspections. Reports of recent events affecting the safety and well being of residents have not been reported to the Commission by the home. Examination of a sample of employment records indicated significant weaknesses in the recruitment of staff, which could place residents at risk of harm and injury, from unsuitable staff. The home does not manage the finances of residents; residents who are unable to undertake this responsibility personally have nominated relatives, friends or other representatives to do this on their behalf. Records are kept of accidents and their investigation; to minimise risks of accident recurrence it is recommended that periodic audit e.g. of time, place, person, activity, be recorded to identify any trends or high aspects of risk. Records indicated that fire safety equipment has been checked and tested at the required frequencies. It is recommended that the fire safety assessment be expanded to include a detailed escape plan including reference to the currently accommodated residents. A sample of records relating to the maintenance and safety of the premises and equipment were examined and found to be in good order, including those for the stair lift, bath seat and gas and electrical installations. The manager was unable to supply written evidence of the periodic safety checking of portable electrical items and of the safety of the water supply with regard to bacteriological analysis; it is recommended that both these aspects receive early attention. Records showed that the mobile hoist was last checked for Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 23 safety during March 2007; the home is recommended to obtain the advice of the manufacturer regarding the desired frequency of such checks. Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 24 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 2 2 Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A 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 Timescale for action The registered person shall, after 01/09/08 consultation with the service user, or a representative of the service user, prepare a written plan (‘the service users care plan’) as to how the service users needs in respect of health and welfare are to be met, and shall keep the plan under review: Care plans and other care records must be improved to ensure provision of accurate information to staff to enable them to properly care for residents. Requirement Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 26 2. OP9 13 (2) The registered person shall make 01/08/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This means that: An accurate record of each instance of medicine administration must be kept for each resident. When a variable dose is prescribed (e.g. “give 1 or 2 tablets”) the amount actually administered on each occasion must be recorded. The practise of obliterating erroneous entries in MARs and care records by the use of correcting fluid, or over-sticking strips of paper, must cease; incorrect entries should be crossed through, rewritten and signed and dated by the person making the entry. The registered person shall make 01/10/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This means that a suitable facility storage for Controlled Drugs must be made available. The registered person shall give notice to the Commission without delay of the occurrence of any event in the care home which adversely affects the wellbeing or safety of any service user. 3. OP9 13 (2) 4. OP33 37(1)(e) 01/08/08 Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 27 5. OP36 19 The registered person shall not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in Schedule 2 of the Care Homes Regulations. 01/08/08 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. 3. Refer to Standard OP1 OP8 OP9 Good Practice Recommendations The fee range should be specified in the service user guide. Care staff should receive training to ensure they observe good practice when assisting residents to eat. The maximum/minimum temperatures of the medicines storage cabinet should be monitored and recorded daily to ensure that medicines are not damaged by incorrect storage. In accordance with good practice the administration of Temazepam should be in accordance with Controlled Drugs methodology. When a medicine is prescribed for ‘as required’ administration, the intended reason for administration (e.g. ‘anxiety’, ‘abdominal pain’) should be written on the administration record. All handwritten MAR instructions should be signed and dated by the author and countersigned by a person who has checked the accuracy of the record. Each MAR should bear an allergy statement about the particular resident e.g.’ Allergies? None known’ or ‘Allergic to Penicillin’. There should be evidence of good practice in meeting the nutritional needs of residents. The staff recruitment reference request form should be amended to include the date on which the reference is written by the referee. DS0000071379.V367798.R01.S.doc Version 5.2 Page 28 4. 5. OP9 OP9 6. OP9 7. 8. 9. OP9 OP15 OP29 Milton Lodge 10. OP33 11. 12. 13. 14. OP38 OP38 OP38 OP38 There should be continuous self-monitoring of the service, using an objective, consistently obtained, reviewed and verifiable method and internal audit should take place at least annually. Periodic audit of accident details e.g. of time, place, person, activity, should be recorded to identify any trends or high aspects of risk. The fire safety assessment and escape plan should be expanded to include specific reference to the currently accommodated residents. There should be written evidence of the periodic safety checking of portable electrical items and of the safety of the water supply with regard to bacteriological analysis. The home should seek advice from the mobile hoist manufacturer regarding the desired frequency of safety checks. Reports of monthly visits by the provider should be either kept in the home or periodically forwarded directly to the Commission to ensure this information is available to inform future inspections. 15. OP38 Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: 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 © 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 Milton Lodge DS0000071379.V367798.R01.S.doc Version 5.2 Page 30 - 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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