Inspection on 15/08/05 for Preston Lodge

This inspection was carried out on 15th August 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.

Other inspections for this house

Preston Lodge 29/09/08

Preston Lodge 18/10/07

Preston Lodge 05/06/06

Preston Lodge 01/02/06

Preston Lodge 16/03/05

Preston Lodge 18/05/04

Similar services:

Spinney (The)

Queen Elizabeth House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Preston Lodge 291 Preston Road Harrow Middlesex HA3 0QQ Lead Inspector Bernard Burrell Unannounced 15 August 2005, 10:00am 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. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Preston Road Address 291 Preston Road Harrow Middlesex HA3 0QQ 020 8904 2866 020 8621 1788 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) Mrs Juliette Taylor Mrs Juliette Taylor CRH PC Care Home only 6 Category(ies) of OP Old Age 65 Years and over registration, with number of places Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: No Date of last inspection 16 March 2005 Brief Description of the Service: Preston Lodge is registered to provide accommodation and care support to 6 elderly people. The home is a semi-detached property located on a main road. It has two floors and an attic flat. There is also an electric wheel chair lift that takes resident who are wheel chair users to the bedrooms on the first floor. All of the bedrooms except one are single occupancy with washbasins. One bedroom is shared by two residents. The home is within easy access to public transport services and local shopping with health and social care facilities and services within easy reach of the home. The home is owned and manged by the registered manager. At the time of this inspection, the duty roat recorded that 11 staff worked at the home. However, the maanger stated there are only 8 care staff providing support to the service users on a 24 rota system. The manager also reported that a care staff who provides night cover support lives at the home. Entrance to the home is accessible by wheel chair users and there is off street parking spaces at the forecourt of the home. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day. The process involved tour of the home and review of the facilities and services, reading of documents, including case files, discussions with the manager, staff and residents. The inspection findings indicated that residents reported they are generally satisfied with life at the home and the quality of care offered by staff. Many of the requirements and recommendations from the last inspection reports were still outstanding at the time of this inspection. There were several areas of shortfalls identified in the inspection findings, including ones that had potential negative impact on the welfare and wellbeing of residents. What the service does well: What has improved since the last inspection? What they could do better: Over the last few years, the management of the home has switched from two owners to one. This according to the current manager has partly accounted for the slow progress with upgrading and renovation of the home internally and externally because of financial constraints. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 6 The following concerns must be dealt with immediately by the manager/provider- carry out improvements in the safety and access to the external sections of the garden. There needs to be improvements and changes to the safety procedures and practices in the kitchen, including food handling and preparation, better storage of food items, regulation of the hot water system and better storage of cooked food items in the fridge. The current practice of taking clinical waste through the kitchen area and disposal of clinical and household waste in the same wastebin must be changed. Better and safer system is needed for the storage of certain medicines, including diabetic medication. Medication should never be left on the kitchen shelves but must always be stored and locked in the medicine cabinet. The current procedure and practices of staff and volunteer recruitment must be improved to help ensure the safety and welfare of the residents is fully protected. No person should be employed to work at the home unless they are fully suitable to do so and the home has received satisfactory CRB and employment references for them. Each new staff must complete an application form and a formal interview and assessment of their competence and ability. Better system and plans must be in place to improve on staff training, development and supervision. In addition, assessment and care planning must improve so that there are clear guidelines of how each resident would like to have their needs and daily care support given. Improvement is needed in the management of the home, including organisation of documentation and case files. The manager must also ensure the CSCI is notified of significant events affecting residents or the operation of the home in line with Regulation 37 of the Care Standards Act 2000. The manager must provide evidence to the CSCI that the home is financially viable and that there are adequate resources to carry out the general maintenance and improvement work needed. 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. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 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 Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 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) 1, 2, 3,5 Work is needed to help ensure each resident has a comprehensive care needs assessment and individual care plan is linked to the assessment. The manager will need to ensure each resident has a completed statement of terms and conditions of their tenancy plus copies of the statement of purpose and service user guide. EVIDENCE: The home’s admission procedure is inadequate and do not allow for comprehensive care needs assessments to be carried out for each user. Although there were assessments for residents who are the responsibilities of local social services, the case notes showed that these were not adequately linked to care planning. It was also not possible to get an informed overview of each resident’s individuality and circumstances from the documented information. The inspector however had discussions with some residents and this helped to learn more about their lives and background circumstances. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 9 The home has not carried out its own care needs assessment and the overall care plans tended to be sketchy and needed to be more individually focused with clear indication of expected outcomes plus how each resident wishes to have their care delivered. The residents confirmed they had opportunity to visit the home and assess the facilities before deciding whether to move in. The manager will also need to ensure that each resident is given a copy of the service users’ guide and statement of purpose when they move to the home. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 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) 7,8,9,10. Some progress has been made to ensure resident has links to relevant health care services. However, there was poor organisation of records, case files and management of clinical waste plus insufficient evidence of reviews and comprehensive risk assessment for each resident. EVIDENCE: The examination of case files showed that each resident was assigned to a local doctor with evidence of medical appointments undertaken. There was also evidence of professional input and services provided by opticians, chiropody and other medical health care professionals. There were several recordings of one resident having a history of frequent falls. Risk assessment was carried out with instructions for staff to observe and monitor this resident’s movements. The inspector also observed this resident had a near fall during the inspection process. There was no evidence of the home notifying the CSCI about these incidents in line with the requirements of Regulation 37 of the Care Standards Act 2000. The inspector had discussion with care staff about the risks faced by some residents because of poor mobility. The responses indicated that some needs were being addressed but there was a lack of clear plans and guidance. This Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 11 approach appeared to depend on staff memory and verbal communication systems. There is the need for the health care needs of all residents to be formally reassessed with clear risks assessments and care plans that is made known to all staff. There was recorded evidence that prescribed medication was given to residents in July 2005 on more than one occasion by a care staff with no formal training in the administration of medication. This practice is contrary to the assurance given by the manager that only two staff are allowed to administer medication. There was also a box of prescribed medication left on a kitchen shelf. The inspector advised the manager that all prescribed medication must be stored securely in the medicine cabinet. There is also the need for the home to have a special fridge to safely store certain medication such as diabetic medicines. There is need for a comprehensive review of the policy and procedure dealing with medication administration and health and safety procedures such as safe disposal of clinical waste. The staff also need to have relevant training in medication administration, food handling and other health and safety matters. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14, 15 The activity rota was limited in its range and creativity with little evidence of programmes developed to reflect the individuality of each resident. The weekly menu and daily meal provisions offer some element of choices to residents. EVIDENCE: The inspector noted during the inspection process and also on the activity rota programme that much of the resident’s time appeared to be taken up with sitting in front of the television. A few residents informed the inspector they did not mind the television been constantly switched on. A few were also engaged in reading newspapers, but at least two showed no interest and had no form of social stimulation. The manager provided an activity rota for 2005. This outlined the following activities planned: singing, long walk, video/film, knitting, bingo, reading newspaper and watching television. The rota stated that staff should encourage the residents to participate in the various activities. The manager and staff reported that residents are given choices and are free to do what interests them. However, the inspector was of the view that the home must make better attempt to capture the social and leisure interests of each resident and devised care plans and provisions to meet those needs. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 13 The provider must ensure that the access path leading to the garden is made safer so that residents wishing to use this area, are able to do so when they like. Meals are planned on a weekly rota system and some choices are offered to resident who might want alternatives. There were also recordings in each resident’s daily case notes about the types of meals they had. There was instruction about the dietary needs of one resident who is diabetic. However, this was poorly recorded and signposted in her care plan. Her medication was also inappropriately stored in the main domestic fridge. There is need for the manager to provide training opportunity in food and hygiene matters for all staff. The storage of food items in the kitchen and other areas of the home also needed improvements, particularly items stored above the heating system in the kitchen. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 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 standard(s) 17,18 Some residents had independent understanding and awareness of the complaints procedure and what to do if they had concerns. Others had the support of their relatives. There was evidence of poor employment practices that left all residents vulnerable to potential abuse. EVIDENCE: The home had policy and procedure dealing with abuse matters, but these needed regular reviews and updates. There was insufficient evidence of training offered to all staff in the protection of adult abuse. There was evidence of staff employed by the manager to work at the home without completing an application from, getting adequate and verifiable employment references and CRB checks. One resident told the inspector she was happy to see that the CSCI was carrying out regular inspection and she felt reassured by the inspection process. The manager will need to ensure that all regular visitors and volunteers to the home are appropriately vetted and relevant CRB checks are sought. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 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 standard(s) 19, 20,21,22,25,26 Some safety measures have been put in place to enhance the safety of residents, staff and visitors, However, there are a number of upgrading, renovation work plus other environmental matters outstanding to help enhance safety and comfort around the home.. EVIDENCE: Fire safety doors, alarm and emergency alert buttons have been installed in all the bedrooms. All the bedrooms are on the first floor and accessible by the stairs or an electric stair lift used by residents with mobility problems. The fire extinguisher near bedroom four needs to be positioned safer to prevent potential accidents. Each room is adequately furnished and equipped to assure comfort and privacy to meet the needs of residents. However, two residents are currently sharing one bedroom. The manager stated the two residents agreed to share and this arrangement has been approved by their relatives and made know to Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 16 the CSCI registration. There was no condition of registration seen by the inspector in the home’s registration certificate. Thermostat valve is need on all central heaters There is a toilet on the ground floor and a bath and toilet facilities on the upper floor. Work is still outstanding to upgrade these facilities. Work is also outstanding to upgrade the bedrooms, kitchen area, the small office and other internal and external areas of the home. Work is also need to remove a dysfunctional back stairway that leads from a resident’s bedroom to the garden. The fire inspection service has made recommendations for this to be done several months ago, but this was still outstanding at the time of this inspection. Work is also needed to repair the main stairway carpet, water damage to the ceiling and electrical system in the staff changing and locker room. In addition, work is needed to improve the uneven pavement at the back of the house and a stairway leading from the dining area to the garden. The provider needs to ensure access to the garden is improved, include the installation of a ramp that is safer for residents to use. Work is also need to cut overhanging branches in the garden. Storage facilities in the kitchen area and garage were cluttered and poorly maintained in some areas. The heating system in the kitchen underneath the storage cupboard also needed to be removed or better protected to minimise the damage been caused to food items stored in the cupboard. Clinical and household waste should be better stored and according to standard health and safety procedural guidelines for care homes. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 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 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) 27,29,30 The procedures for the recruitment of staff are not robust and do not offer protection to people living in the home. Several staff do not receive adequate and relevant training to help enhance their professionalism. EVIDENCE: The manager stated that 7 care staff are employed by the home to meet the needs of the six residents. Two staff work on the morning shift that changes in the late afternoon period. There is one staff that work on the night shift as a waking and one other sleeping who reportedly live in the attic flat, but no employment records were available for this staff. The staff files and rota examined by the inspector indicated the home had not undertaken all the necessary recruitment checks to ensure protection of residents. For example, there were unexplained gaps in the employment history of several staff. Some staff had no employment references, induction checklist, no evidence of CRB checks, health immunisation or contract of employment. On the day of this inspection a new worker started at the home as a cleaner. She was allowed to work for several hours without supervision. The manager was not able to provide any employment information for this worker. The inspector reminded the manager that it was a breach of the Care Standards Act 2000 to employ staff to work at the home without adequate employment procedures and checks being carried out. The worker was asked to leave the home by the manager before following the advice from the inspector. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 18 The names of two additional cleaners were also listed on the staff rota for week of 01-28 August 2005. However, the manager stated she no longer had applications details for the two workers and that the assistant manager put the names on the rota by error. She also stated that the workers had stopped working at the home a few weeks before this inspection. There were insufficient evidence of staff qualifications, training, supervision and appraisal. The manager stated that some records were available but could not be located. Staffing records were poorly organised and of the 7 staff reportedly working at the home, only 3 had completed training in adult protection at the time of this inspection. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 19 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) 37,38 33, 34,36, The home is managed by the provider/manager and residents appeared to benefit from clear leadership. However many practices and conditions at the home do not promote and safeguard the safety and wellbeing of residents. EVIDENCE: The registered provider is also the manager of the home. Until recently, it was jointly owned. The manager stated that effort is being made to secure additional financial funding from the bank to carry out repair and renovation work, many of which were identified in previous inspection reports but were still outstanding at the time of this inspection. A few residents who spoke to the inspector reported that they were satisfied with life at the home and the care and support they received from the staff and manager. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 20 The manager has not provided the monthly Person In Control (PIC) reports or the Regulation 37 accidents and incidents reports to the CSCI in line with the requirements of the Care Standards Act 2000. The inspector saw recorded evidence of accidents involving a resident who has had several serious falls in April and August 2005 and other dates. However, no reports of these were sent to the CSCI. The manager stated that one resident managed her own finance and five others receive assistance or power of attorney from their relatives and next of kin. There were evidence of an inspection of the pluming and heating system carried out in January 2005 and the electrical testing in May 2004. However, the inspector saw water damage to the electrical system in the staff changing room. The manager stated an electrician has advised that the electric should be switched off in this area and there was plan to have this fixed. The home’s record keeping, including several policies and procedures were poorly maintained and needed reviewing, updating or archiving. Externally, several areas of the home including- pavements, ramp, stairsneeded to be either removed, repaired or rebuilt. The manager will also need to ensure she provide evidence to the CSCI of her effort to do the Registered Manager Award (RMA) training. The inspector is of the view this would offer her invaluable knowledge and skills to enhance her professionalism and management of the home. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 21 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 3 2 3 x 3 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 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 3 3 3 3 2 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x x 3 2 x 2 2 2 Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 22 Yes 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 2 Regulation 5(1),(b),( c), schedule 4.1 15, schedule 3.1(b) Requirement The manger must ensure that each resident is given a written contract/statement of terms and condition of their tennancy. The manager must ensure that care needs of each resident is clearly set out in their individual care plans, and are linked to comprehensive care needs assessments and reviews. The manager must ensure that better and safer systems are put in place for the storage of diabetic medicines. The manager must ensure that medicines are never left on kitchen shelves or other places other than the appropriate storage facilities. The manager must ensure that relevant training in medication admnistration is provided to all staff. The manager must also ensure that the review of all residents medication is carried out in conjunction with with their local doctor. Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 23 Timescale for action 30 October 2005 30 October 2005 2. 7 3. 9 13 (2) schedule 3.3(i),(k), 18(1), 24. 30 September 2005 4. 12 12,(1), (b), 16. 5. 18 6. 19 7. 20 8. 25 & 26 The manager must ensure that the social,leisure, cultural activities and plus lifestyles of each resident is linked to their care needs assessment and personal wishes. These must be clearly recorded in their care plans and kept under review. 10(1),12, The manager must ensure that 13(6),37 all staff receive training in adult (g) protection and that residents are fully protected from all forms of abuse by the policies, procedures and practices at the home. 16,13 The manager must ensure that the safety of all residents, staff and visitors are safeguarded at all times and that the home has a programme of general maintenance for the home. 16, 37, The manager must ensure that 13(4), 23 access and safety to the garden (2),(b) area is improved and can be used safely by residents. All ramps, rails, stairs and pavements must be improved to make them safer or minimise the potential risks that currently exist. 23, 16.13. The manager must ensure that improvement is carried out to repair electrical faults in the home. The manager must ensure that the health and safety guidelines are followed when handling and disposing of clinical and household waste The manager must ensure that clinical waste is not transported through the kitchen or dining areas. The manager must ensure the home is adequately staffed at all times with staff who have the relevant skills and experience to 30 October 2005 30 September 2005 30 October 2005 30 October 2005 30 September 2005 9. 27 19, schedule 2, 23 30 October 2005 Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 24 meet the care needs of residents 10. 28 & 29 13(6),19, 39. The manager must ensure the residents are adequately protected by improvements in the homes recruitment policy and practices. The manager must ensure that no one is employed to work at the home unless they are fit to do so. The manager must esnure that anyone working at the home as a paid or voluntary worker, is fully vetted with a satisfactory CRB clearance, employment references where appropriate and completion of an application form. Gaps in employment must be accounted for. The manager must ensure that all staff received relevant training and are competent to do their jobs. Staff should also have completed or undertaking the required NVQ training. The manager must ensure that she undertake the relevant Registered Manager Award (RMA) training. The manager must ensure that the homes is financially viable with adequate resources to carry on the business. The manager must submit a copy of the homes current financial statement/business plan to the Commission by the timescale date. The manager must ensure that there is planned programme of 30 October 2005 11. 30 & 31 19, schedule 2(6),9 30 October 2005 12. 34 25 30 September 2005 13. 36 18,19 30 October 2005 Page 25 Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 14. 37 & 38 17,sch 3,4, 12, 13 (4), 16 (2) (k), 37, 44 supervision and staff appraisal programme for each staff. The manager must ensure improvements are made in the homes record keeping, reviews and updating of its policies and procedures. The manager must ensure that the health, safety welfare of residents and staff are adequately promoted and protected at all times. Appropriate action plans must be put in place to minimise the risk of falls faced by residents at the home. The manager must ensure that all relevant systems and practices are in line with relevant legislative guidelines. The manager must ensure that the CSCI is notified on time of any accidents, incidents or events affecting residents, staff or operations at the home. 30 October 2005 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 Good Practice Recommendations Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection 4th Floor, Aspect Gate 166 College Road Harrow, Middlesex HA1 1BH 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 Preston Lodge G62-G11 S17481 Preston Lodge V244306 150805 Stage 4.doc Version 1.40 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. 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!