Inspection on 04/02/09 for Milton Lodge

This inspection was carried out on 4th February 2009.

CSCI found this care home to be providing an Poor 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milton Lodge 01/08/08

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Milton Lodge 32 Milton Road Bournemouth Dorset BH8 8LP     The quality rating for this care home is:   zero star poor 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: Gloria Ashwell     Date: 0 4 0 2 2 0 0 9 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 32 Information about the care home Name of care home: Address: Milton Lodge 32 Milton Road Bournemouth Dorset BH8 8LP 01202556873 01202316881 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Kensington Care Ltd care home 18 Number of places (if applicable): Under 65 Over 65 0 18 dementia old age, not falling within any other category Additional conditions: 18 0 The maximum number of service users who can be accommodated is 18. 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) Dementia (Code DE) Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 32 Brief description of the care home 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 inspection was (per person) from £500 to £570. Up to date information on fees can be obtained from the service. Care Homes for Older People Page 5 of 32 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: zero star poor 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: The quality rating for this service is 0 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. This inspection was carried out by two inspectors, and throughout the report the term we is used, to show that the report is the view of the Commission for Social Care Inspection. This inspection was unannounced; the inspectors arrived at 11.00 on 4 February 2009, Care Homes for Older People Page 6 of 32 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, being the combined total of hours spent in the home by the two inspectors, was 13 hours. During the inspection, particular residents were case tracked; for example, for evidence regarding Standards 7, 8 and 9, records relating to the same residents were examined and the residents spoken with. During this inspection compliance with all key standards of the National Minimum Standards was assessed. What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 32 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 9 of 32 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. Prior to admission, the needs of each proposed resident are assessed to ensure the home will be properly able to meet them. Evidence: No new residents have been admitted to the home since the last inspection. The registered manager had recently visited the private address of a prospective resident to assess the persons needs. We examined the records the manager had written had found them to be informative, relevant and clear. In advance of making the decision to enter the home the closest relatives of this prospective resident visited Milton Lodge to view the premises and meet residents and staff. Following preadmission assessment of the prospective residents needs and circumstances the home will write to them describing the agreement and ability to Care Homes for Older People Page 10 of 32 Evidence: provide accommodation and care. Care Homes for Older People Page 11 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is insufficient evidence that residents receive the care they need. Associated records and care practices require improvement to ensure staff have sufficient guidance to enable them to properly care for and protect residents from the harm and ill health that unplanned and potentially inappropriate care and incorrect medicine administration might cause. Evidence: Prior to the last inspection of October 2008, to improve the standard of care planning the home introduced a new system of documentation but the home remains in the process of transferring the records of all residents to the new system. Accordingly, the standard of record keeping is variable e.g. we examined samples of records of all people currently accommodated and for one could not find a care plan, for others found care plans written some months ago and not subsequently updated to reflect their current condition, some had only the old style care plans which fail to provide sufficient information and for a very few the care plans were up to date and Care Homes for Older People Page 12 of 32 Evidence: reliable. The majority of records examined were of generally poor standard, and failed to provide reliable evidence that these people were receiving the care they needed. For example, one resident was recorded to have experienced sudden ill health including bleeding, but records provided no evidence of associated care assessment or subsequent action. Another resident has diabetes and although the home has routinely recorded the results of blood tests, care records provided no indication of the safe levels and no guidance to staff on what action to take if these levels were breached. Records examined for one resident contained information relating to a different resident, because they had been incorrectly computer generated; accordingly the records were wholly inaccurate and misleading. For a number of residents records were written very rarely, and thereby failed to provide sufficient information about progress of particular health conditions including wound management. One resident has a urinary catheter but there is no guidance to staff on the correct management of this item, another resident has daily applications of olive oil to ears, but the care plan makes no reference to this. A number of residents have creams applied but records fail to state the reason, the name of the cream, the site or frequency of application. One person uses a bed fitted with rails and for another records state that an alarm pad is used; the home has not recorded risk assessments for these items. Alarms pads and bedrails may constitute forms of restraint but the home has not obtained the consent of the residents or their representatives to their use. During January 2009 the home has written at least 4 reports of a resident being physically aggressive and intent upon self harm, but has not reviewed the findings of an assessment written during December 2008 which states that there has been no aggression and challenging behaviour, and the care plan makes no reference to these aspects. 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. Previous inspection reports have included the requirement to cease the use of oversticking strips of paper to obliterate incorrect record entries. Care Homes for Older People Page 13 of 32 Evidence: The requirement is repeated because these practices have continued. 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. Standards for medicine handling must be urgently improved. On our arrival in the home we observed a senior carer signing Medicine Administration Records (MARs) in the office, having some time earlier administered the medicines. To ensure accuracy of safe and correct administration MARs should be signed immediately after each incidence of administration. We asked the care worker if she knew she was breaching the homes administration procedure and she said she did. 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. At the time of the inspection containers of eye drops were kept in the kitchen fridge in a plastic food container and a bottle of antibiotic syrup was free standing in the fridge door. All medicines must be kept in locked storage. Examination of MARs indicated a number of areas where improvement is necessary. For example for one resident prescribed the medicine Quetiapine 25mg with directions Take half a tablet twice a day, a handwritten change had been made by crossing out the words HALF A changed to ONE but this alteration was not signed, dated or countersigned by a person who had checked the amendment for accuracy. Another resident was prescribed the drug Co-Codamol with instructions take 1 or 2 four times a day as required but the home held no information on the reason for possible administration and had not given the medicine to the resident since the MAR commenced on 15 January 2009. The MAR of a resident stated that Diprobase cream was to be applied to an affected area 4 times a day when required but gave no indication of the affected area or reason Care Homes for Older People Page 14 of 32 Evidence: for application. This person was also prescribed Paracetamol take 2 four times a day as required. The chart started on 15 January 2009 and recorded that the medicine had been given daily 4 times a day, but with no indication of what it was required for. A resident was prescribed Hypromellose eye drops Use to the affected eye/s as directed and the MAR commenced on 15 January 2009 recorded it to have been administered 4 times daily since that date. A senior care worker said it was administered as 1 drop to the persons right eye although the home had no written direction in this regard. Guidance on the container states that the usual dose is 1 to 2 drops 3 times daily and that the product should be discarded 28 days after opening. The home has not recorded the opening date. Another resident was prescribed Chloramphenicol eye drops, but the MAR started on 15 January 2009 provides no evidence the eye drops have been administered and the senior care worker said none had ever been supplied to the home. One person is prescribed Lactulose take 2 x 5ml spoonfuls at night but records indicate it is being given daily at 12.30. This person is also prescribed Co-Codamol 500mg take 2 four times a day. Since the current MAR commenced on 15 January 2009 the home has not administered the medicine to the person, recording that it is prescribed on an as required basis and has not been required, this conflicts with the prescription which has been for regular administration. One person is prescribed Lactulose take 2 x 5ml spoonfuls twice each day but records state it has been given 3 times on 4 recent days. For one person the MAR states for Sudocrem Apply as directed, but there is no direction. This person is also prescribed the antibiotic syrup Cefalexin 5 ml, 4 times a day for one week. Records show that at the time of inspection the person had already received 36 doses given over 9 days, although the course should have completed at 7 days, with 28 doses. In accordance with a recommendation made in the report of the last inspection the home has obtained a cabinet for the storage of Controlled Drugs. This cabinet should be firmly fixed to a wall, by the approved method. Also in accordance with recommendations made in the report of the last inspection the home has obtained a thermometer to monitor medicine storage area temperatures and is keeping records of the temperatures, and is recording administration of Temazepam in a Controlled Drug register. Care Homes for Older People Page 15 of 32 Evidence: In the presence of staff residents appeared relaxed and confident but the nature and frequency of interaction with staff appeared minimal and generally confined to the carrying our of specific tasks e.g. movement to the dining room for lunch. Care Homes for Older People Page 16 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are few opportunities for the residents to engage in recreational and social activities; in consequence many are likely to become bored, apathetic and restless.Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home.Residents do not have sufficient choice of the meals that are provided to them. Evidence: A programme of activities was seen to be kept in the managers office. It is recommended that a copy of the programme of activities be prominently displayed in a location where residents can see it. The home does not employ an activities organiser instead placing reliance on care staff, who also carry out all housekeeping duties including cleaning and cooking. It is recommended that a person skilled in arranging a variety of social and recreational activities suited to the preferences and abilities of residents be engaged. No social activities were seen to take place during this inspection although the inspectors were later told that a ball game had taken place during the morning. Care Homes for Older People Page 17 of 32 Evidence: There was little positive engagement observed between residents and staff other than to perform tasks and staff were frequently heard advising residents to sit down. There were no opportunities for residents to help themselves to snacks and beverages outside the set times for serving these. Staff said that if residents asked for snacks or drinks they would be provided, but because many of the currently accommodated residents have varying degrees of dementia it is unlikely these persons would make such requests, although they may be encouraged to help themselves to drinks and foodstuffs if they are made freely available to them. Residents able to express an opinion did not know if there is a menu for the week and none was seen displayed during the tour of the home. Residents confirmed they are offered a choice at breakfast and supper, but some said that for the main meal of the day, served at midday, there is no choice of main course or dessert. The serving of lunch was observed and it was noted that the only alternative to the main dish was a cold platter, comprising boiled potatoes, ham and beetroot. Some institutionalised practices were observed, including the failure to provide people with a choice of lunch time drink, all residents having been given the same diluted cordial in plastic beakers. It is recommended that improvements be made to the meal provision to ensure that residents are provided with sufficient choice. Care Homes for Older People Page 18 of 32 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 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. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall aspect does not present a homely environment ideally suited to the confused elderly people living there because signage is poor, there are few opportunities for activity, and in consequence residents are likely to experience greater levels of confusion, bewilderment and boredom. The temperature of living areas was uncomfortably cool until intervention by the inspection team. Many parts of the home present a shabby aspect and at the time of our inspection no assisted bathing facilities were available. 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. 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 Care Homes for Older People Page 20 of 32 Evidence: 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. Residents can bring items of their own furniture and belongings to keep in their bedrooms, in accordance with the agreement and safety 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 relevant legislation. Drying is done outside or in a drying room. Recent improvements to the home include provision of a ground floor wet room comprising a toilet, wash hand basin and suitable for use by people with mobility difficulties. Window repairs have been made and safety locks fitted to minimise risks of accidental falling from windows on the first floor. During the morning of the inspection a number of residents said they felt cold and the home was not heated to a comfortable temperature. At the suggestion of the inspectors the ambient temperature of home was increased; the registered manager said there had recently been problems with plumbing which she believed had caused the reduction in heating efficiency. A number of beds were seen to have been poorly prepared e.g. one had a torn lower sheet, and soiled underclothing in the bed. Other beds had wrinkled sheets, crumbs and other debris in the beds, and badly torn mattress covers. Signage is minimal and residents were seen to have difficulty in finding their way around the home. Care Homes for Older People Page 21 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of 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 but must improve aspects of employment 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 and found to contain 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. The home requests two references, including at least one from a past employer, we recommend a reference be also obtained from previous employment working with vulnerable people, if there has been such previous employment. It is also recommended that the application form request reasons for leaving each previous employment. It was also noted that the visa conditions of two care workers limit their work to 20 Care Homes for Older People Page 22 of 32 Evidence: hours plus 15 extra hours in the home, with the option to exceed this at public holiday and term breaks. However, during the week preceding the inspection each was recorded to have worked 48 hours and thereby exceeded the permitted maximum. The manager said that most of the care staff currently employed by the home hold a National Vocational Qualification (NVQ) so the home meets the standard for at least 50 of staff to hold 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. The home is recommended to update the training matrix to ensure accuracy and ease of maintaining training status awareness. Care Homes for Older People Page 23 of 32 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. 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 the standards of care and medicine handling and associated record keeping must be improved. Evidence: Mrs Haworth is the Registered Manager and holds qualifications in management and care and is able to demonstrate that she keeps up to date with training. She is supported by a deputy manager and a team of care and household staff. During 2008 the home 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 generally positive with good comments being made about the service but quality assurance monitoring has not been implemented as a core management tool; this report contains an associated recommendation. Care Homes for Older People Page 24 of 32 Evidence: The manager said that a representative of the provider organisation visits the home regularly, and showed the associated reports completed during December 2008 and January 2009. Examination of a sample of employment records indicated some 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 again recommended that the fire safety assessment be expanded to include a detailed escape plan including reference to the currently accommodated residents and reviewed to ensure it meets current standards. A sample of records relating to the maintenance and safety of the premises and equipment were examined and provided evidence that routine checks and tests are carried out to ensure the safety of the various items and installations. Care Homes for Older People Page 25 of 32 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 7 15 The registered person shall, 01/09/2008 after 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. This requirement was issued following the key inspection of August 2008; it has not been met and is therefore repeated. 2 9 13 (2) The registered person shall make 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 01/08/2008 Care Homes for Older People Page 26 of 32 administration must be kept for each resident. The practise of obliterating erroneous entries in MARs and care records by the use of correcting fluid, or oversticking strips of paper, must cease; incorrect entries should be crossed through, rewritten and signed and dated by the person making the entry. This requirement was issued following the key inspection of August 2008; it has not been met and is therefore repeated. 3 9 13 (2) The registered person shall make 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. 01/10/2008 Care Homes for Older People Page 27 of 32 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 1 25 23 The temperature of all rooms 27/02/2009 used by residents must at all times be maintained for their comfort and safety. For the comfort and safety of residents. 2 38 13 The registered person shall ensure that unnecessary risks to the health and ssafety of service users are identified and so far as possible eliminated. It is required that fire extinguishers be fixed in position, not free standing, due to the risk of injury presented if these items should be knocked and fall over. 23/03/2009 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 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home 02/03/2009 Care Homes for Older People Page 28 of 32 Lockable storage faciliteis must be provided for medicines requiring cold storage. 2 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home The Controlled Drug cabinet must be securely fixed by approved means. 3 26 13 The registered person shall 09/03/2009 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. This means that the shower hose must be prevented from being placed in the bath, damaged and dirty bed rail covers must not be used and throughout the home adequate standards of hygiene must be maintained and good hygiene practise promoted. 4 38 13 The registered person shall 02/03/2009 ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. This means that: there must be reliable evidence that when potential restraints e.g. alarm pads 30/03/2009 Care Homes for Older People Page 29 of 32 and bedrails are used it is in accordance with robust consent and assessment processes, kept under continuous review and designed to ensure the safety of service users. 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 12 It is recommended that a copy o the programme of activities be prominently displayed in a location where residents can see it. It is recommended that a person skilled in arranging a variety of social and recreational activities suited to the preferences and abilities of residents be engaged. The kitchen waste bin should have a well-fitting lid. Improvements should be made to the meal provision to ensure that residents are provided with sufficient choice. The living accommodation should be improved to provide an environment promoting best practice, specifically suited to the special needs of elderly people with dementia. The door of bedroom 8B has a second handle which can be operated from inside which should be removed or rendered inoperable to reduce the risks of a resident becoming locked in. Effective action should be taken to keep the premises free from offensive odours. Damaged and discoloured sealant around baths should be replaced. The staff/visitor toilet should not be used to store unrelated items which may pose a risk of cross-infection. Bathroom waste bins are of open style and should be replaced with items of non-hand operated style. The home should take appropriate action to ensure that the employment conditions of staff are not compromised. 2 12 3 4 5 15 15 19 6 24 7 8 9 10 11 26 26 26 26 29 Care Homes for Older People Page 30 of 32 12 29 A reference should be obtained from previous employment working with vulnerable people, if there has been such previous employment, and the application form should request reasons for leaving each previous employment. The training matrix should be updated to ensure accuracy and ease of maintaining training status awareness. 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. Denture cleaning tablets should be securely stored to avoid risks of accidental swallowing. 13 14 30 38 15 38 Care Homes for Older People Page 31 of 32 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 © (2009) 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. 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