Inspection on 14/12/06 for Park House

This inspection was carried out on 14th December 2006.

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 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

Park House 12/09/07

Park House 13/03/06

Park House 09/08/05

Park House 23/02/05

Park House 06/09/04

Park House 17/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Park House Park House 7 Manor Road St Marychurch Torquay Devon TQ1 3JX Lead Inspector Graham Thomas Unannounced Inspection 14th December 2006 10:00 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 Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park House Address Park House 7 Manor Road St Marychurch Torquay Devon TQ1 3JX 01803 314897 01803 323784 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) Mr Christopher Norman Bennett Mrs Diane Winifred Bennett Lorraine Barbour Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (21), of places Physical disability over 65 years of age (21) Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate up to 2 Service Users over 60 years. Date of last inspection 13th March 2006 Brief Description of the Service: Park House is a large detached property with pleasant gardens situated in a quiet residential area on the outskirts of Torquay. The home is close to local amenities. It is registered to provide care for older people including those with physical disabilities and/or dementia, and up to two people aged over 60 years. At the time of this inspection, 20 people were living at the home. Two were sharing a room and the remainder were in single rooms. Fifteen of the rooms have en-suite facilities. There are two spacious lounges and a separate dining room. Part of one lounge is used as the office. A shaft lift provides access to the upper floor. At the time of this inspection fees ranged between £331 and £400 per week Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the Inspection the Registered Provider completed and returned a preinspection questionnaire. Nine surveys were sent to service users. Five were returned. Six surveys were sent to staff. Five of these were returned. The Inspector visited the home and spent one and a half days there. During the visit he looked around all the rooms in the building. Many service users have difficulty in communicating. The Inspector and spoke with four service users individually and spent time with a group in the lounge area. Staff were observed going about their work. Four staff were interviewed. The Inspector also spoke with the Registered Manager and the Registered Provider. Three relatives spoke with the Inspector during his visit. A visiting Healthcare Assistant from the District Nursing Team also spoke with the Inspector. Various records were examined including care plans, staff files and health and safety records. What the service does well: What has improved since the last inspection? What they could do better: • All staff ought to be able to refer to the care plans easily • Staff do not record the use of medication properly. This creates risks for service users. • When service users share a room, their consent to this should be recorded. Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 6 • The home’s policy about abuse needs to be updated • The garden should be safe for people with dementia • Staff should make sure that toilets are cleaned properly towels are available for hand washing • Skin creams should be labelled to protect service users from infection • Staff must be trained in first aid so that there is always a trained person available. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Park House DS0000018407.V314672.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3 and 6: Quality in this outcome area is good. People seeking a place at Park House can feel assured that their needs will be sufficiently well assessed before they move in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose and Service Users’ Guide. It was recommended at the last inspection that these should include details of room sizes and staff numbers. No modifications have yet been made. A sample of six service users’ files was examined. Copies of statements of terms and conditions were seen in these files. They did not specify the room to be occupied by the service user Each file contained a basic assessment which had been carried out by the home before the service user moved in. Other assessment information had been obtained from the referring agencies. Copies of letters were seen stating that the home could meet the person’s needs and offering a place in the home. Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 9 The home does not provide accommodation solely for intermediate care. Park House DS0000018407.V314672.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10: Quality in this outcome area is adequate. Service users personal and health care needs are generally well met. However they are placed at potential risk by poor practice concerning medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users’ files were stored in a locked cabinet in the home’s second “quiet” lounge. Every service user had a plan of care. A sample of six was examined in detail. Details of the individual’s life history were recorded in the files. This gave the reader an indication of their personality and interests. Health and personal care needs were recorded in the plans. Weight and nutritional monitoring forms had been completed in some files. All the plans showed evidence of eye tests. Chiropody treatment was recorded in one file. Risk assessments were seen in the files concerning issues such as selfmedication and falls. Moving and handling assessments were seen in each file. The plans had been reviewed monthly in keeping with a previous recommendation. Changes in the person’s needs were identified in these reviews. A letter was seen inviting relatives to be involved in the review of the plan for a service user. Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 11 Staff stated that they could gain access to the plans but they did not routinely consult them. The Inspector spoke with the Registered Manager about making the plans more accessible to all day and night staff. A visiting Healthcare Assistant from the local District Nursing Team visited during the inspection and spoke with the Inspector. She commented that the home always carried out treatment regimes for prescribed for individual service users. She also stated that her team was kept informed of any changes in a service user’s condition. A visiting Doctor spoke very briefly with the Inspector during the visit and stated that he had “no concerns” about the home. At the time of the inspection, two service users had infections which required additional infection control measures. Aprons, gloves and antibacterial hand wash was available in their rooms. In discussion staff were aware of the additional precautions they were required to take. The home’s systems for administering medicines was examined. The Registered Manager stated that training was provided by the supplying Pharmacist. A “monitored dosage system” was in use. The ability of service users to administer their own medication had been risk assessed. Medicines were stored in a locked cupboard. Additional security was in place for controlled drugs though none was in use at the time of this visit. Medication for three service users was examined. In all three cases the medicines administration record had blank spaces which should have been signed or coded by staff. In some cases the tablets concerned remained in the cartridge. This suggested that the medicine had been refused or not given. In other cases the medicine had been removed from the cartridge. What had happened to these tablets was therefore unknown. These errors had occurred over a three week period. There was no record indicating that the errors had been noted or that any action had been taken. Some medicines were labelled “as required”. No directions were in place for staff to identify the circumstances in which the medicines should be given or the maximum dosages. Some medicines were labelled “as directed”. There was no clear record available for staff as to the meaning of this instruction. Telephone instructions regarding medication (for example changes in dosage) were recoded in the home’s daily records which were kept separately from the medicines records. It is recommended that all directions and instructions regarding an individual’s medication should be held together to reduce the risk of error. During the inspection staff were observed treating service users respectfully and knocking on doors before entering rooms. The service users and visitors who spoke to the Inspector all felt that staff were respectful. Two service users Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 12 were sharing a room at the time of this visit. Screening was available if required. Consent to this sharing arrangement was said to have been given but there was no record of this in the individuals’ files. Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12–15: Quality in this outcome area is good. Service users are able to exercise sufficient choice about their individual lifestyles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A list of activities for service users was posted in the lounge. This included a visiting musician and another entertainer. Three service users who spoke with the inspector referred to these activities which they said they enjoyed. One service user stated that he preferred to spend time in his room. A folder of activities is available for staff reference. Staff conducted a short “proverbs and sayings” activity with service users on the first afternoon of the inspection visit. The Inspector spoke with the Registered Provider and Manager about the possibility of using personal histories to develop individual activities. Visitors to the home all spoke highly of the welcome they receive. All said that they are routinely offered refreshment and receive a warm welcome from the staff and Registered Provider. Visiting arrangements were said to be flexible and open. All confirmed that they could see their relative in private if they wished. Relatives stated that they were kept informed of any significant events. Observation and discussion with service users showed that they had choices within the daily routines of the home. Service users confirmed that they were Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 14 able to choose whether or not to join in activities. During the inspection visit some had chosen to spend time alone in their rooms whilst others joined fellow residents in the lounge. Some service users chose to take their meals in their rooms rather than the dining room. In individual rooms there were many personal possessions which service users had chosen to bring to the home. Due to dementia, many service users have difficulty in decision-making. The Registered Provider stated that their financial affairs are dealt with by relatives or professionals. This was confirmed in discussion with visiting relatives. Short observations were made of two mealtimes. These were unhurried occasions during which service users were offered discreet assistance by staff. The meals were sufficiently well presented and contained fresh ingredients. The menus seen indicated a varied and wholesome diet. During the inspection visit drinks were served at regular intervals throughout the day. Dietary needs were written down in individual plans. Dietary weight monitoring had been undertaken for service users where a difficulty had been identified. Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards16 and 18: Quality in this outcome area is good. Service users can feel confident that their concerns will be treated seriously. There are sufficiently robust systems in place to protect service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Policies and procedures had been produced concerning complaints and the Protection of vulnerable adults from abuse. A complaints procedure was displayed in the home and is described in the Service Users’ Guide. A complaints record was seen by the Inspector. This showed the action taken about complaints. Those relatives and service users with whom the Inspector spoke felt that they would be able to raise concerns with the Registered Provider. All felt that their concerns would be taken seriously. The Policy concerning the Protection of vulnerable adults from abuse was examined. This did not conform to current local and national practice guidance and required modification. The Registered Manager was, however, aware of current good practice. In discussion, staff were clear as to whom they would report any incidence of actual or alleged abuse. In keeping with a previous requirement training for staff in the protection of vulnerable adults was being undertaken. All staff had received in-house awareness training. Guidelines and worksheets completed by staff were seen by the Inspector. Some staff had attended external training including the Registered Manager. The Registered Provider stated that all staff would receive this training as places became available on the local multi-agency course. Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 24 and 26: Quality in this outcome area is adequate. Service users live in a generally comfortable and attractive home. However, some unacceptable risks are posed by hygiene and infection control practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Inspector examined the whole of the premises. The ground floor accommodation comprises a kitchen, dining room, and two lounges, one of which contains records in locked cabinets. There are also six bedrooms on the ground floor. A laundry and food store are sited in a small outbuilding. Opposite the kitchen there is a bathroom with an assisted bath. A toilet on the ground floor is reserved for staff and visitors’ use. Access to the first floor is provided by stairs and a shaft lift. This was seen in use during the inspection. A further eleven bedrooms are sited on the first floor. There is also a bathroom with an assisted bath and shower and an additional toilet. Fifteen of the individual rooms have en-suite facilities. Locks to individual rooms, toilets and bathrooms were all capable of being opened from the outside with a coin or key. This reduces the privacy and security of Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 17 these rooms. The Registered Provider stated that these were unlikely to be changed. On inspection the home was generally clean and mostly free from offensive odours. Furnishings were homely and comfortable. The lounge had recently been redecorated and the hall was in the process of redecoration during the visit. A number of bedrooms had been supplied with new chests of drawers and bedside cabinets. Soft furnishings had also been replaced in these rooms. Carpets had been replaced in two rooms where trip hazards had previously been identified. One individual room had a strong odour and the carpet was heavily discoloured. The needs of the service user occupying this room were discussed with the Registered Provider and Manager. It is recommended that these should be reviewed with the referring agency. Hygiene and infection control measures were examined. Liquid soap was provided at communal wash hand basins. Towels were not consistently supplied to these areas. Aprons, gloves and antibacterial hand wash were available in service users’ rooms where there was an infection risk. In discussion staff were aware of infection control procedures. Communal and some en-suite toilets were fitted with frames or booster seats. These were in good condition and outwardly clean. However, the undersides of some of these seats and the toilet bowls where they were resting were stained with dried urine and faeces. This presents a hygiene risk. The issue was discussed with the Registered Provider and Manager who undertook to modify the cleaning regime accordingly. Some service users’ rooms contained skin creams without labels. This presents a risk of cross-infection. The home’s kitchen was clean. Food in fridges and freezers was appropriately stored. The laundry had cleanable walls and an impermeable floor. The home has a spacious and attractive garden. From the garden there is open access to the car park and a busy main road. The facility is not, therefore, suitable for people with dementia Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27-30: Quality in this outcome area is adequate. There is an adequate number of trained or experienced staff at most times. Service users’ safety at night is compromised at times by the absence of a first aider. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Inspector examined a sample of four staff files and interviewed four staff. Other staff on duty during the inspection were spoken with informally. Staff rotas were examined. Information in the rotas was further checked by examination of staff pay records. Records showed that in addition to the Registered Manager, there are generally three staff on duty between 8:00am and 8:00pm. On several occasions staffing fell below this level. In the late evening and overnight there are two staff on duty. Other staff are employed specifically for cleaning and cooking. The staffing complement includes the Registered Provider who works in the home and shares some of the Managerial tasks. The levels of staffing during the inspection visit appeared to be sufficient to cater for the twenty service users’ immediate needs. The Registered Provider and Manager stated their reluctance to use agency staff. They expressed appropriate concern regarding issues of consistency and knowledge of individual service users. However, the Registered Provider is advised that where staff shortages occur, the safety of service users must remain a paramount consideration. Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 19 Three of the eleven care staff held a National Vocational Qualification in care at level 2 or above. One other was working towards this qualification. In addition, staff had received training in specific subjects either in-house or by attending short courses. All had received in-house training in the protection of vulnerable adults pending the availability of places on a local course. Other training undertaken by staff since the last inspection included infection control, dementia awareness, fire safety, and first aid. Not all the night carers had received first aid training. This means that first aid cover at night could not be guaranteed. Staff files revealed sound recruitment practices. These included formal application and interview, the taking up of references and Criminal Records Bureau checks. In discussion the Registered Provider and Manager were aware of the requirements for supervising staff whose Criminal Records checks could not be completed before appointment. Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38. Quality in this outcome area is adequate. Service users benefit from a generally well managed home. However, the health and safety of service users is potentially compromised by various training, medication and infection control issues identified in this report. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Diane Bennett, the Registered Provider and Lorraine Barbour, the Registered Manager, both hold relevant qualifications which include the Registered Managers Award. They have many years experience in the care of older people. Management tasks are shared between the Registered Provider and Manager. Both also undertake care work in the home. There are various systems in place to monitor the quality of the service provided. An extensive audit was undertaken in August 2006. Records were also seen of regular “walk through” environmental checks. These were Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 21 discussed with the Inspector. These management auditing systems could be improved by translating the findings into clear development plans. The Registered Provider stated that service users’ finances were managed by service users’ relatives or other representatives. This was confirmed in conversation with relatives. Various records were seen which showed satisfactory routine maintenance of the home’s equipment and systems. These included, for example, lift servicing and electrical appliance testing. Risk assessments had been produced for the home’s environment. These included a recently completed risk assessment for Christmas decorations. Staff had received training in health and safety subjects. However, not enough staff had been trained in first aid to guarantee this cover at night. Some issues in hygiene and infection control procedures have been identified in the “Environment” section of this report (Standards 19-26) Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 22 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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 X X X 2 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Timescale for action The registered person shall make 14/01/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In particular, the medicine administration record must be signed by staff when medicines are administered or the appropriate coding entered on the sheet. The Registered Manager must audit the medication records to account for all medication and write to the Commission to confirm that this audit has been completed. The registered person shall make 14/02/07 suitable arrangements for the training of staff in first aid. In particular, a staff member trained in first aid must be available at all times. Requirement 2 OP28 OP38 13(4) Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 24 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 OP1 Good Practice Recommendations The statement of purpose/service user guide should be amended to include information regarding the sizes of rooms and a staff list showing the number and qualifications of staff currently employed. Service users’ statements of terms and conditions should show clearly the room to be occupied. If a service user moves to another room new terms and conditions should be issued. The Registered Manager should consider ways in which the care plan can be made accessible to all day and night staff as a working document The prescribing GP should be asked for specific directions, preferably in writing, for medicines labelled “as directed”. Where directions are taken by phone, these should be written down and signed. Specific directions for staff should be produced for any medicine prescribed “as required”, in consultation with the prescriber. Such directions should include the reason for the medication, the circumstances under which it is to be administered and the maximum dosage to be given in a defined period. Instructions regarding changes to medication should be kept with the administration record A record should be kept of the consent of any service user to share a room. The sharing arrangement should be made clear in the terms and conditions The home’s policy and procedure concerning the protection of vulnerable adults from abuse should be modified to accord with local and national guidelines. The garden should be made more secure to meet the needs of the service users with dementia. The management should review the type of locks in use and the practice of locking doors to communal facilities The cleaning regime should be reviewed to ensure that all toilets, booster seats and frames are thoroughly cleaned. Staff should ensure that fresh towels are available at wash DS0000018407.V314672.R01.S.doc Version 5.2 Page 25 2 OP2 3 4 OP7 OP9 5 OP9 6 7 8 9 10 11 OP9 OP10 OP18 OP20 OP24 OP26 Park House 12 13 OP26 OP38 hand basins. All skin creams should be labelled with the name of their user. The quality audits should be used as a basis for a clear development plan for the home Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Park House DS0000018407.V314672.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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