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Inspection on 01/11/05 for Old Gates Nursing & Residential Home

Also see our care home review for Old Gates Nursing & Residential Home for more information

This inspection was carried out on 1st November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents who returned comment cards said they liked living in the home and felt well cared for. All those spoken with said the staff were very good. Their comments included; "great staff," "they are very good with me," "they are a good lot" and "if you need anything they are always there for you." Residents were pleased that they were able to bring some of their own furniture and ornaments into the home. One resident said "my room`s my own to clutter up if I want." Another talked about how nice it was to have her own things around her and one resident said, "my room`s lovely." Residents had opportunities to make their views about Old Gates known either by returning questionnaires or during meetings. The manager drew up plans to improve the service based on residents` comments.

What has improved since the last inspection?

A statement of terms and conditions of residency had been drawn up and given to all new residents. This ensured that residents knew what services they could expect and helped to prevent misunderstandings. There had been an increase in the number of residents who were seen and assessed by staff before they were offered a place in the home. The quality of care plans on Rowan House had improved. The plans were clear and made sure that staff knew what care the resident needed to meet their needs.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Old Gates Nursing & Residential Home Livesey Branch Road Feniscowles Blackburn Lancashire BB2 5BU Lead Inspector Jane Craig Announced Inspection 1st November 2005 09:00 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 Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 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. Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Old Gates Nursing & Residential Home Address Livesey Branch Road Feniscowles Blackburn Lancashire BB2 5BU 01254 209924 01254 200948 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) BUPA Care Homes Limited Mrs Vivien Ogden Care Home 90 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (29), Old age, not falling within any other of places category (30), Physical disability (7), Physical disability over 65 years of age (30) Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. Within the overall total of 90, maximum of 29 service users requiring nursing care or personal care who fall into the category of DE(E) Within the overall total of 90, a maximum of 30 service users requiring nursing care who fall into the ctegory of PD(E) Within the overall total of 90, a maximum of 30 service users requiring personal care who fall into the category of OP Within the overall total of 90, a maximum of 5 service users requiring nursing care who fall into the category of PD Within the overall total of 90 a maximum of 2 service user requiring personal care who falls in the category of PD Staffing for those service users requiring nursing care on Holly House will be in accordance with the Notice issued dated 25 May 1999 Staffing for those service users on Rown House to be maintained as agreed 28.8.03 The Registered Provider should, at all times, employ a suitably qualified and experienced Manager who is registered with the Commission for Social Inspection Within the overall total of 90, one named service user requiring nursing care who falls into the category of DE When the named person (see conditions 9 above) no longer resides at the home an application for a variation to registration must be made. 28th June 2005 9. 10. Date of last inspection Brief Description of the Service: Old Gates Nursing and Residential Home is owned by BUPA Care Homes Limited. The home provides long stay and respite care for up to 90 adults who require help with personal care or who have nursing care needs. The home is a modern, purpose built, single storey building. It comprises one reception area and three separate houses. Holly House accommodates service users with nursing care needs. Rowan House accommodates service users who have a diagnosis of dementia and Cherry House accommodates people who require assistance with personal care. Each house has its own lounge/dining area and small kitchen. There are 30 single bedrooms in each. The bedrooms do not have en-suite facilities but there are sufficient bathrooms and toilets close to bedrooms and communal areas. Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 5 Old Gates is situated in a residential area, close to local amenities, including a Post Office, churches, public houses and shops. It stands in landscaped grounds with several garden and patio areas. There are adequate car parking spaces. Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which meant that the residents and staff were told beforehand when the inspector would be arriving. The inspection took place over two days. At the time there were 82 residents accommodated in the home. The inspector met with residents from each of the houses and spent time observing interactions between staff and residents. Some residents were able to talk about their experiences of living in the home. Their views and comments form part of this report. Four residents also completed comment cards before the inspection. The inspector spoke with three visitors to the home. Nine other visitors had returned comment cards. With the exception of two, all comments were very positive. The home was in the process of recruiting a new manager. Discussions were held with the acting manager who had been in post for a few months. Eight other members of staff, including the staff in charge of the houses, also contributed to the inspection process. A tour of the premises took place and a number of documents and records were viewed. Detailed notes were taken, which have been retained as evidence of the inspection findings. What the service does well: Residents who returned comment cards said they liked living in the home and felt well cared for. All those spoken with said the staff were very good. Their comments included; “great staff,” “they are very good with me,” “they are a good lot” and “if you need anything they are always there for you.” Residents were pleased that they were able to bring some of their own furniture and ornaments into the home. One resident said “my room’s my own to clutter up if I want.” Another talked about how nice it was to have her own things around her and one resident said, “my room’s lovely.” Residents had opportunities to make their views about Old Gates known either by returning questionnaires or during meetings. The manager drew up plans to improve the service based on residents’ comments. Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 7 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. Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 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 Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 The statement of terms and conditions clearly set out the services and facilities provided at the home. Inadequate pre-admission assessments sometimes resulted in a lack of understanding of residents’ needs and inappropriate placements. EVIDENCE: Following a recommendation from the previous inspection a statement of terms and conditions of residency had been drawn up. The statement was included in the information pack given to all new residents. There had been an improvement in the pre-admission process in that staff from the home assessed most residents before offering an admission. However, each house used a different assessment tool and the quality of information gathered varied between the three houses. Some assessments did not provide enough information about the resident’s needs in order to draw up an initial care plan. Two residents on Holly House had been assessed but staff had not taken into account the skills and experience of the staff team or the needs of the existing residents as part of the assessment. Consequently residents were still being admitted inappropriately. One relative said, “they didn’t understand his needs at first.” Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 and 9 The lack of detailed, up to date information in care plans may result in inconsistent care and residents’ personal, health and social care needs not being met. Risk assessment and management strategies were inadequate and may result in harm to residents or staff. Some medication handling practices were unsafe and placed residents at risk. EVIDENCE: Files of residents from each house were inspected. Each house used a different care plan format and there were differences in the quality of plans between each house. Plans on Rowan House had improved and were generally of a good standard. They provided staff with the information they needed to meet residents’ needs. Relatives had signed their agreement to the plans. Monthly evaluations were informative and summarised the resident’s progress. However, the plans were not always updated when changes occurred. On Holly House there were some very detailed plans that provided staff with clear directions on how residents’ needs were to be met. Others did not address identified needs. Monthly evaluations did not provide any meaningful information. There was no evidence that residents or relatives were involved in drawing up or evaluating care plans, although one relative said she regularly Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 11 discussed her relative’s care with the staff and another said she was always contacted when there were any changes in her mother’s condition. Plans on Cherry House were incomplete. For example, two residents, whose assessments showed difficulties with mobility, did not have care plans to direct staff how to meet their needs. Other important information was missing and many of the plans did not provide sufficient directions for staff. Plans were not signed or dated by staff and there was no evidence that the resident or their relative had been involved in or agreed to the care plans. Despite shortfalls in the written plans, residents said they felt well cared for. One said, “we are well looked after here.” Most care files contained risk assessments for moving and handling, nutrition, falls, pressure sore risk and potential risks to the individual, for example, use of bed rails. On Rowan House plans to minimise risk were drawn up and evaluated every month. Healthcare needs of residents on Holly House were generally assessed and management strategies drawn up. However, these were not always reviewed. For example, one resident had two accidents after having bed rails fitted but their use was not reviewed. Risk assessments on Cherry House were incomplete. Two residents who had moving and handling risks had not been assessed. Another resident had been assessed as being at risk of developing pressure sores and of falling. There were no care plans to assist staff to manage these risks and protect the health and safety of the resident. Ongoing physical health care needs were monitored. A relative said that staff at the hospital commented on how well cared for her mother was when she took her to a recent appointment. Referrals to outside agencies were made as required. The previous requirement to incorporate advice from other professionals in the resident’s care plan had only been partially met. 2 Requirements and 7 recommendations to improve the management of residents’ medication were made following the last inspection. Three of the recommendations had been actioned in all three houses. Implementation of the rest was not consistent across the home and they remain in place. A further recommendation was also made to monitor stocks of medicines not stored in the monitored dose system. Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 Residents who were able were encouraged to make their own choices and decisions. However, lack of written information may result in wrong decisions and choices made on behalf of less able residents. The lack of recreational activities meant that some residents’ social interests and needs were not being met. EVIDENCE: Residents said that routines in the home were flexible and they were able to make choices and decisions for themselves. One said, “There are no rules about getting up or going to bed.” Another said, “We can more or less do what we want, when we want.” Two of the residents who completed comment cards said they would not like to be more involved in decision making within the home and two said they would. Staff said they sometimes had to make choices on behalf of residents who were less able, and they did this by getting to know their likes and dislikes and talking to relatives. Some of the care plan documentation had space for recording this type of information so that it could be passed on to other staff. However, the plans on Rowan House were not complete in this respect. Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 13 The activity co-ordinator had been absent for a number of weeks and there were mixed comments about the level of activities provided by other staff in the home. One resident who returned a comment card said there was a lack of suitable activities; others said there were enough. Some residents said they occupied themselves with reading, watching TV and doing puzzles but planned activities for other residents were haphazard. One resident said there used to be activities but not at the moment. A relative said there was a lack of stimulation for residents. Staff said they organised games when they could but this was not a regular occurrence. Most staff said they were unable to fit activities into their daily routine and one member of staff had given up her afternoon off to organise a game of bingo for the residents. Special events were celebrated and several residents said how much they had enjoyed the recent Halloween party. Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The lack of staff training and awareness in adult protection issues may result in incidents not being reported or handled appropriately. EVIDENCE: Residents who returned comment cards said they felt safe at the home. Those spoken with named staff who they would go to if they had any concerns about the way they were treated. Some staff had received update training in adult protection issues as required following the previous inspection. Other staff were awaiting courses. Three senior staff spoken with were unclear about their roles in dealing with suspected or alleged abuse. Staff on Holly House must receive training on how to deal with challenging behaviour. They must cease the practice of using “breakaway” techniques unless they have received adequate training as this may cause harm to the resident and staff. Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 There was a poor standard of décor and furnishings and a deterioration in cleanliness and hygiene in some areas of the home. This detracted from residents’ comfort. EVIDENCE: Most staff said that minor faults were repaired in a timely fashion. There was a programme of routine maintenance and a plan for redecoration and refurbishment. Grounds were well maintained. Some areas of the home were well maintained and decorated. One resident said, “it’s very nice here, bright and airy.” Another said, “my room’s nicely decorated and I have a comfortable bed.” However, several areas in the home were in need of redecoration and/or refurbishment. Some of the furnishings in Rowan House were looking shabby and in need of a deep clean. Several bedrooms needed redecorating. New carpets had been laid in the corridors of Cherry House and a lounge carpet was on order but several bedrooms needed redecorating and new flooring. There was a good standard of décor and furnishings in the communal areas of Holly House but some of the bedrooms needed repainting. The floor Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 16 covering in at least 7 rooms must be replaced where the vinyl is badly marked and beyond repair. The standard of cleanliness and hygiene in some areas of the home had deteriorated since the previous inspection. One of the bedrooms in Rowan House had faeces on the window frame, walls and floor. Another had a bloodstain on the wall. Both rooms had been cleaned just before the inspection. Several other rooms were unclean and malodorous. At least three of the bedroom carpets on Cherry House needed cleaning and some of the bedroom walls had not had spillages wiped away. At the time of the inspection the standard of hygiene on Holly House was satisfactory although one bedroom was malodorous. The fluorescent lights in the corridors in all of the houses needed cleaning. Following previous recommendations bedroom door locks had been fitted. Residents, who wished to, held their own keys. Bedside lighting should be provided so that residents do not have to get out of bed to turn their light on or off. One relative said she had provided the bedside light. Residents were generally happy with their rooms. Many had personalised them to a high degree and they were comfortable and homely. One resident said, “I have a comfortable room with all my own things around me.” Another said, “My room’s my own to clutter up as I want.” Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Residents’ social and recreational needs were not always met which may be due to shortfalls in staff or inappropriate deployment of staff. EVIDENCE: There was a duty rota for each house showing which staff were on duty and at what times. Residents were very complementary about the staff teams. Their comments included; “great staff,” “they are very good with me,” “they are a good lot” and “if you need anything they are always there for you.” Some residents and relatives said that that there was sometimes a shortage of staff. One relative wrote that her father’s personal hygiene was not always attended to because there were not enough staff to give him a bath. Another relative said “sometimes they are short on staff but you can always get hold of one.” Some staff said there were sufficient numbers on duty at all times. Other staff said that there were insufficient staff to organise regular recreational activities because they were too busy with indirect care tasks such as putting laundry away. Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38 Systems were in place to review and improve the quality of care provided, which included seeking views of residents and their relatives. The lack of fire safety training potentially placed residents, visitors and staff at risk of harm. EVIDENCE: The home was without a registered manager at the time of the inspection. The temporary manager had been in post for approximately 4 months. She had the relevant qualifications and experience to manage the home. An annual survey was sent out asking for residents’ views on various aspects of the home and their care. BUPA were working with outside agencies to find a method of seeking views of residents with dementia. The manager and heads of department conducted an annual internal audit, which covered areas such as care, training, catering, laundry, administration, management and Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 19 information. The manager addressed any shortfalls in standards via the annual development plan. There was a ‘personal best’ initiative throughout the company where staff were rewarded for good practice, which improved standards. Resident and relative meetings were held occasionally. The home had a health and safety audit earlier in the year. An action plan had been drawn up to address shortfalls. A previous requirement to provide all staff with up to date fire safety training had not been actioned. Most staff had been involved in fire drills but had not had prevention training. There were no risk assessments for potentially hazardous items that may be stored in residents’ rooms, for example, Steradent or creams and lotions. Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 20 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 3 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X X X 2 X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 2 Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1) Requirement Residents must not be offered admission unless their needs have been fully assessed and can be met at the home. Care plans must set out details as to how the resident’s needs are to be met. (Timescale of 31/08/05 not met) Care plans must be kept up to date in accordance with changes in the resident’s care needs. (Timescale of 30/06/05 not met) The registered person must provide opportunities for residents or their representatives to be involved in drawing up and reviewing care plans. (Timescale of 30/06/05 not met) The registered person must ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. This would include the risk of falls, nutritional risk, risk of pressure sore development and manual handling risks. (Timescale of 31/08/05 not met) The registered person must DS0000022478.V254254.R01.S.doc Timescale for action 31/12/05 2 OP7 15(1) 31/12/05 3 OP7 15(2) 31/12/05 4 OP7 15(1)(2) 31/12/05 5 OP8 13(4) 30/11/05 6 OP8 13(1) 30/11/05 Page 22 Old Gates Nursing & Residential Home Version 5.0 7 OP9 13(2) 8 OP9 13(2) 9 OP12 16(2)(nm) 13(6) 10 OP18 11 OP18 13(6) 12 OP19 23(2)(d) 13 OP26 16(2)(k) 14 OP38 23(4) ensure that any advice or treatment plans proposed by other health care professional are adhered to. (Timescale of 30/06/05 not met) The manager must ensure that self-medication is promoted where appropriate. Risk assessments must be completed (and reviewed) and the resident provided with secure storage facilities within their private room. (Timescale of 31/07/05 not met) Medicines must only be administered to the resident for whom they were prescribed. There must be no sharing of tablets, creams or other preparations. Suitable arrangements must be to enable residents to engage in local, social and community activities. The registered person must ensure that staff have training in adult protection and are aware of their responsibilities in handling any allegations. (Timescale of 31/08/05 not met) Staff who are providing care for residents who are aggressive must have training in managing challenging behaviour. Restraint or other breakaway techniques must not be used without prior training. The registered person must ensure a reasonable standard of decoration in all areas of the home. The registered person must ensure that all parts of the home are kept clean and free from offensive odours. (Timescale of 31/07/05 not met) The registered person must make arrangements for all staff DS0000022478.V254254.R01.S.doc 30/11/05 04/11/05 31/12/05 31/12/05 31/12/05 30/04/06 30/11/05 31/12/05 Page 23 Old Gates Nursing & Residential Home Version 5.0 15 OP38 13(4) to receive training in fire safety. (Timescale of 31/07/05 not met) Risk assessments must be conducted where potentially hazardous items are stored in residents’ rooms. 31/12/05 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 OP9 Good Practice Recommendations Criteria for the administration of when required and variable dose medication should be clearly defined and recorded for all service users prescribed such items. A second member of staff should witness all hand written annotations on Medication Administration Record charts. The opening date should be recorded on eye drops, insulin and other items with a short shelf-life Medication trolleys should be secured to the wall when not in use Stocks of medication not stored in the monitored dose system should be monitored. Care plans should contain details of residents’ likes, dislikes and preferences about their daily life and routines. Furnishings in individual rooms should include bedside lighting. Staffing levels throughout the home should be reviewed in accordance with residents’ needs and dependency levels. 2 OP9 3 4 5 6 OP9 OP14 OP24 OP27 Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Old Gates Nursing & Residential Home DS0000022478.V254254.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!