Inspection on 25/08/05 for Nightingale House (Nightingale Lane)

This inspection was carried out on 25th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 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

Nightingale House (Nightingale... 10/07/06

Nightingale House (Nightingale... 26/01/06

Nightingale House (Nightingale... 10/01/05

Nightingale House (Nightingale... 28/05/04

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Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Nightingale House 105 Nightingale Lane London SW12 8NB Lead Inspector Jon Fry Unannounced Thursday 25 August 2005 10:00 am th 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 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. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Nightingale House Address 105 Nightingale Lane London SW12 8NB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8673 3495 0208 675 2258 Nightingale House Soobhug Awatar CRH Care Home 253 Category(ies) of DE Dementia (39) registration, with number OP Old Age (253) of places Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of beds that are residential is 144 2. The total number of beds that are nursing is 109 Date of last inspection 10/01/05 Brief Description of the Service: Nightingale is a large home providing a specific service for the needs of elderly people who are Jewish or of the Jewish faith. The establishment has three residential units and three nursing units. A fourth unit (previously in use as residential) was closed for re-development at the time of this inspection. The home benefits from having a large activities department in addition to its own Therapies Department. Other facilities available include a Synagogue, concert hall and landscaped gardens. The home is situated close to local amenities and public transport. The internet address for the home is www.nightingalehouse.org.uk Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two regulation inspectors on the 25th August 2005 for approximately seven hours. A further unannounced inspection visit was undertaken by a specialist Pharmacist inspector on the 20th September 2005. The inspection visit of the 25th August 2005 focused on two units only - the “Main Building” nursing unit that provides care for people with dementia and Ronson residential unit. During the course of this visit the inspectors had the opportunity to speak individually with twenty residents, six members of care staff, the personnel manager, the registered manager and the deputy chief executive of the home. What the service does well: What has improved since the last inspection? The inspectors were again able to identify continued improvements in the service provided to residents. The management of the home have stated their commitment to providing high quality and ‘compassionate’ care - this is being achieved by ensuring that staff are well trained and that good practice is implemented throughout the home. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 6 Staff spoken to were positive regarding the support and training provided to them. The attitude and approach of care staff has improved noticeably within the past two years in the opinion of the inspectors. This has had an enormous impact on outcomes in terms of the quality of care provided to residents. An improvement was noted in the auditing and storage of medication by the pharmacist inspector since the last visit. 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. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 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 standard(s) 3 and 4. The home ensures that the needs of any new resident to the home can be met by carrying out a pre-admission assessment. Continued improvements in the overall service provided mean that residents can be further assured that their individual needs will be met at the home. EVIDENCE: As stated in the summary of this report, feedback from residents was very positive regarding the service provided to them at the time of this inspection. One resident stated that the care was ‘great’ and another new resident reported that it ‘couldn’t get better’. A comprehensive procedure is in place at the home to ensure that the individual needs of residents are assessed prior to admission. The format in use for assessment has been reviewed and updated in 2005 and a further assessment is utilised following any hospital stays by individual residents. The inspectors noted continued improvements in the update of care plan documentation at the time of this inspection. This ensures that any changes in assessed needs are fully addressed by the service on an ongoing basis. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 9 A meeting for new residents and their relatives was seen to be scheduled for September 2005. This aimed to provide individuals with an informal opportunity to ‘get to know’ the management at the home. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 10 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 standard(s) 7, 8, 9 and 10. The changing needs of residents are addressed by the home. Care plans in place are fully completed and subject to a recorded process of monthly review. Residents benefit from good access to health practitioners as required. The home has arrangements for the ordering, supply, storage, recording, disposal and auditing of medication and has access to a pharmacist for advice. Inconsistencies, errors and omissions in recording and errors in administration of medication were found that may have an effect on the health and welfare of residents although there had been improvement in the auditing and storage of medication since the last visit. EVIDENCE: Three care plans were seen for residents living in the “Main Building” which provides care for people with dementia. Care plans were updated monthly to ensure that the current needs of residents are recorded, and that staff are aware of the individuals needs. The care plan includes health needs. One resident had a bruise on their shin. The nurse record indicated when the cut was first noted by staff, and the size Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 11 of the wound. A month later the state of the wound was observed and recorded, the following month the matter was recorded as resolved when the risk of infection had been eradicated. These actions safeguard the resident’s health. A health care worker spoke about a resident and their duties as key worker. The member of staff was able to illustrate their work with the resident through using the care plan which described dietary needs, the risk assessment resulting in the use of bed sides to ensure the resident’s safety. A record was maintained of the residents bathing pattern for their personal hygiene. For another resident the member of staff reported that the resident had “regular small falls”. The falls are recorded in the accident book when the resident is found on the bedroom floor. A risk assessment must be produced showing how these falls are to be managed and steps taken to reduce the risk of the resident hurting their self in the bedroom. The nutritional assessment for one resident shows that the resident “requires help to eat”. A member of staff reported that the resident “does not feed herself at all”. To ensure that the resident is given the correct help a full description must be given of the type of help needed. To ensure that personal and health care needs are always met, needs must not only be recorded but the impact on residents fully explored in the care plan and the risk assessment. Care plan documentation for three residents was also examined within the residential unit on the day of inspection. Care plans were observed to be fully completed and were subject to a process of recorded monthly review. A new tool for the risk assessment of falls was being piloted within the unit at the time of inspection. The registered manager reported that the home was in the process of reviewing the care plan documentation in use. A recommendation has been included for the home to consider how the plans could be made more ‘person centred’. This is with particular reference to residents with dementia. Individuals were observed to be treated with respect. In the main dining room of the nursing unit, a resident asked staff “can I cut my food” they were handed the cutlery and the member of staff returned to help a few minutes later. Three other residents who still enjoy social conversations were sitting at a table in a lounge for lunch. Such actions by the staff help residents to maintain their dignity. Residents spoken to in the residential unit were complementary regarding the staff working there. One resident reported that staff ‘did everything they could for you’ and another said they were a ‘wonderful crowd’. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 12 The findings of the Pharmacist Inspector following the visit undertaken on the 20th September 2005 were as follows: Policies and procedures were not reviewed on this visit. The pharmacist is writing new standard operating procedures for the home. One nursing unit, the main building and two residential units were inspected. All medications administered by staff along with the records relating to receipt, storage, administration and disposal of medication were examined. Staff on each unit were interviewed and medication for thirty-three residents was counted and compared to the records of receipt and administration to monitor whether residents were administered their medication in accordance with the prescribers’ directions. From these observations and discussions residents are able to self-administer medication after an appropriate risk assessment. This is monitored within a risk management framework. The receipt of the current month’s medication had not been recorded on two units and staff did not seem to be aware that the receipt was to be recorded on the administration record. Seventeen other residents did not have the date of receipt recorded on the administration record. One unit continues to have medication entries on the administration record written by hand. All hand-written entries did not contain the full details of the medication and the dose to be given was written in code and figures rather than in words. In one instance the entry was illegible. The allergy sections on the administration records were not completed for twenty residents on one unit. Seven residents had missing entries on the administration record indicating administration/non-administration of medication. Four residents did not have the actual quantity of medication given recorded for items with a variable dose One resident had been recorded as receiving their medication on one morning when the medication was seen to still be in the monitored dosage system container for that day. All these made it difficult to assess whether residents had received their medication appropriately. The manager and pharmacist perform audit visits on the units on a regular basis. No record is made of these visits. Feedback is given at the team meetings. A system of reporting and monitoring incidents with medication is in place. One unit does not have medication supplied in a monitored dosage system. The amount of medication in stock is recorded on the administration record daily to audit the medication. The amount in stock agreed with the amount that should be in stock for all residents selected on this unit. On other units Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 13 medication not supplied in the monitored dosage system could not be compared to the amount that should be in stock, as the receipt of medication had not been recorded accurately. Three residents had not been administered their medication as directed by the prescriber. One other resident did not have the correct dose of medication on one day according to the records, although staff said that the correct dose had been given. All other records were completed accurately and medication was stored safely and under the appropriate conditions ensuring the health and welfare of residents are protected and a pharmacist is employed in the home for advice, developing the policies and procedures, training of staff and highlights to the GP residents needing medication review. This is reflected in the low use of sedative medication to control behaviour and input into the medication incident reporting system. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 and 15. Residents are given ample opportunities to engage in activities and are able to maintain contact with relatives and friends. Visitors are welcomed to the home. The dietary needs of residents are appropriately catered for. EVIDENCE: Residents have time with the activity co-ordinator to explore their past and present interests in activities. The home has an activity co-ordinator for each individual unit and a number of these staff members are new following a reallocation of duties within the activities department. The members of staff responsible for both units reported that they were assessing individual needs and interests of residents and developing activity plans. For residents who cannot state their interests their participation in activities is noted. An arts and crafts centre within the home offers a variety of activities including painting, cookery, and pottery. One resident reported that they “do exercises”. Other residents stated that there were ‘lots of activities’ and ‘lots going on’. The schedule of activities for July to September 2005 included outings to Kew Gardens, the English National Opera and Leeds Castle. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 15 Residents are encouraged to bring with them their own processions, including items of furniture, the bedrooms reflect the individual. Residents also demonstrated choice when choosing where to sit for lunch. Three residents sit in the lounge where there is “no noise”. They feel this is preferable to sitting with the other residents in the main dining room. This group of residents enjoy social conversation with each other and visitors. A resident reported that the “food is good”. Another resident who needed help from a carer at afternoon tea was heard responding to being offered a choice of coffee or cake. The carer did not assume that the resident wanted a bite of cake and then a drink, but demonstrated patience in asking the resident a question and waiting for a response about what was wanted. The resident stated “no” to more cake and “yes” to coffee. By exercising choice over what to eat and where to sit residents, and are able to maintain their individuality and autonomy. Service users are all Jewish, and to protect their cultural preferences all food provided at Nightingale is strictly kosher. Service users receive a wholesome balanced diet. Feedback regarding the food provided was generally positive and comments included ‘good’, ‘OK’ and ‘could be better’. The catering staff on the residential unit inspected were taking responsibility for serving the meals to residents thus leaving the care staff to concentrate on providing support as required to individuals. This was a pilot study that may be rolled out to change practice in other units. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. Residents and their representatives can be confident that any complaints will be listened to, taken seriously and acted upon. Policies and procedures are in place to protect residents from abuse. Training on the Protection of Vulnerable Adults (POVA) is provided to all care staff. EVIDENCE: Residents spoken to during this visit expressed confidence in the home to deal with any concern or complaint they might have. Comments received included ‘staff listen if you are unhappy with anything’ and ‘no cause for complaint’. As highlighted within the previous inspection report for the service, the home keeps a full record of any complaint along with actions taken and outcomes. Each complaint is rated to a scale indicating level of risk and seriousness of the complaint. Five written complaints had been logged since the last inspection of the home and outcomes were recorded with formal written responses made to the complainants. A record of verbal complaints was seen to be maintained within the residential unit. These evidenced that there had been seven verbal complaints made to care staff within the unit regarding issues such as missing personal items and disputes with other residents. Outcomes for each complaint were observed to be recorded within appropriate timescales and were signed off by the unit manager. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 17 A compliments book is maintained on each unit. Comments recorded within this book held on the residential unit included ‘you all do a fantastic job’ and ‘you are a fantastic team doing a great job’. The deputy chief executive reported that the home had received twenty-one written letters of thanks since the previous inspection took place in January 2005. In order to ensure the protection of residents from abuse all staff have been provided with training on recognising and dealing with any suspected abuse. The induction training for new staff includes abuse awareness and the in-house training programme includes instruction on awareness and procedures to follow. A staff leaflet regarding POVA has been produced to further ensure that all care staff know what action to take. The inspectors were supplied with a copy of the home’s policy on Bruising. This procedure ensures that all incidents of bruising are documented for each individual resident with the appropriate persons notified. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 18 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 standard(s) 19, 20, 21, 23, 24, 25 and 26. Residents of Nightingale House enjoy a comfortable living environment. The premises are well maintained and kept to a good standard of cleanliness. EVIDENCE: Residents spoken to reported their satisfaction with their living environment. Comments made included ‘very clean’, ‘my room is fine’ and they keep the place clean’. The organisation continues to demonstrate a clear commitment to providing a well-maintained and comfortable environment for residents in the home. No maintenance issues were noted within the two units visited during this inspection. Toilet and bathroom facilities were observed to be sufficient to meet the need of residents. Staff maintain a clean and tidy environment for residents. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 19 Building work was noted to be ongoing within the unit situated below Ronson residential unit. This is being fully renovated into a new nursing unit accommodating thirty two residents. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30. Residents were seen to be supported by sufficient staff to meet their needs at the time of this inspection. A programme of training is in place to ensure that individual needs are met by competent staff. EVIDENCE: Feedback from residents regarding the care staff was generally very positive on the day of inspection. Typical comments received included ‘the staff do everything they can to help you’, ‘very good’ and ‘mainly helpful and polite’. The numbers of staff allocated to each unit was observed to be satisfactory at the time of this inspection. All staff and residents spoken to reported that they felt there were enough staff on duty to meet individual care needs. The personnel manager reported that over 70 of care staff were now trained to NVQ Level Two or above. This is to be commended given the scale of training provision required. Records of staff training supplied to the inspectors evidenced that events held in 2005 included Health and Safety, Fire Safety, POVA awareness, medication administration and Passover training. The personnel manager reported on new developments such as enhanced training for senior healthcare workers and further rollout of the dementia training for all staff working at the home. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 21 Lessons for care staff to further improve their written and spoken English are also being provided following requests from individual staff members. Both the registered manager and personnel manager spoke of the improvements being made to further structure the training provision at the home. The inspectors endorse the identified areas for development such as the rollout of enhanced senior healthcare worker training, further dementia awareness training and the creation of a central training database for the home. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 22 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33. The home consults with residents on a regular basis to ensure that the home is run in their best interests. EVIDENCE: Records examined within the residential unit evidenced that monthly residents meetings were taking place and included discussion with residents regarding issues such as the on going building work and social events. The residential unit manager spoke of her attendance at a quarterly relatives meeting. These are held within units throughout the home and a relatives meeting for the home as a whole is held bi-annually. Other quality monitoring systems in place at the home include dedicated food forums and a ‘Home Committee’. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 23 Areas identified for improvement by the residents survey undertaken in August 2004 were being progressed. The deputy chief executive spoke of the current low vacancy rates at the home which impacted positively on the consistency of care for residents. Other areas being developed were the catering services throughout the home and further recruitment of volunteers. The home retained its award status for Investors in People following a review in April 2005. Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 4 x 3 x x 3 x x x x x Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 25 No Are there any outstanding requirements from the last inspection? 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 OP 7 Regulation 12 (1) 13 (4) 15 (1) (2) Individual assessments are fully completed with regard to any identified risk such as falling. The care plan in place fully describes individual support needs and the actions required by care staff to meet these. 2. OP 9 13 (2) The Registered Persons must ensure that all medications are administered as directed unless otherwise indicated and recorded. The Registered Persons must ensure that the administration/nonadministration of all medication is recorded accurately. The Registered Persons must ensure that the receipt of all medication is recorded accurately and consistently across the home. The Registered Persons must ensure that the allergy section on the administration record is completed for all residents. 21.09.05 Requirement The Registered Persons must ensure that: Timescale for action 01.11.05 3. OP 9 13 (2) 21.09.05 4. OP 9 13 (2) 10.10.05 5. OP 9 13 (2) 10.10.05 Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 26 6. OP 9 13 (2) The Registered Persons must ensure that all hand-written entries on the administration record contain full details of each medication and the dosage and are legible. 24.10.05 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. Refer to Standard OP 7 Good Practice Recommendations It is recommended that the care plans in place be reviewed to ensure that they are person centred. Information such as the individual life history, experience and likes & dislikes should be expanded within the individual documentation maintained. It is recommended that the dosage of medication be written fully in words on the administration record. It is recommended that a record be made of the audits of medication done by the manager and pharmacist. 2. 3. OP 9 OP 9 Nightingale House G54-G04 S19109 Nightingale House V245886 250805 Stage 4.doc Version 1.40 Page 27 Commission for Social Care Inspection Ground Floor - CSCI 41-47 Hartfield Road Wimbledon SW19 3RG 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. 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