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Inspection on 20/10/08 for Ravenscroft Nursing Home

Also see our care home review for Ravenscroft Nursing Home for more information

This inspection was carried out on 20th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

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

Ravenscroft is a comfortably furnished, clean and well maintained home in a moorland setting. People`s rooms are very individual and they are helped to make them `homely`. There is a program of continual improvement. Nursing and care staff are well supported by administration, cleaning, maintenance and domestic staff. The registered provider works on the premises and is usually available. All staff are encouraged to take qualifications in care.

What has improved since the last inspection?

Improvement at the home has been rapid since the deputy manager was employed followed by a new manager in August. They are themselves knowledgeable registered nurses and they have improved staff knowledge, skills and sense of responsibility. Staff say they are much happier and now feel properly supported. No requirements were issued following the random inspection in August (one week after the new manager started at the home) although some improvements were and are still being consolidated. People who use the service and their family are now much more confident that people`s needs are being met. They say they can approach the manager knowing they will be listened to and any concern or complaint handled effectively. The registered provider is more closely monitoring standards at the home and there is better information available about making complaints. There are regular meetings for people and staff to express an opinion and regular formal supervision of staff work. People are safer as the standard of care provided is better monitored. People look well cared for. Assessment of need and the planning of care is more detailed. Staff are now fully aware of how to protect people from abuse and how to alert any concerns they might have; policies and procedures are readily available to them and under more regular review.

What the care home could do better:

Despite many ways information is communicated in the home there is still the need for improvement and this has to be better monitored to guarantee that health care concerns are identified immediately. Care plans need to reflect the true situation at all times and staff must follow those plans. Individual risk should be better assessed and include any potential hazard. All medicines (whether prescribed or not) must be recorded as they enter the home so that a full audit is possible. Where a medicine is to be administered `as required` or `as necessary` it must be clearly stated, as part of the plan of care, under what circumstance it may be given. This will better ensure it is given in a consistent way and reduce the likelihood of mishandling.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ravenscroft Nursing Home Old Crapstone Road Yelverton Devon PL20 6BT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anita Sutcliffe     Date: 2 2 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Ravenscroft Nursing Home Old Crapstone Road Yelverton Devon PL20 6BT 01822853491 01822853444 enquiries@ravenscroftcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Vacancy Type of registration: Number of places registered: Ravenscroft Homes Ltd care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 54 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) Date of last inspection Brief description of the care home Ravenscroft is a care home providing nursing and/or personal care for a maximum of 54 residents of either gender with physical frailty, illness or disability. It is situated near Yelverton, West Devon, on the edge of Dartmoor National Park. The home is arranged on 3 floors within an older `Victorian house, plus a more modern extension and purpose built wing opened in September 2005. All rooms in the wing have en-suite toilets. Further improvements to the existing environment are on going. Level access is Care Homes for Older People Page 4 of 29 Over 65 54 0 0 54 Brief description of the care home achieved via 3 passenger lifts. There are 2 lounges and 2 dining rooms. There are large grounds, with grass and paved areas, with level access from the house. Information about the home was found in the entrance hall and people can request a copy of the latest inspection reports from the administration office. Information given to the Commission indicates the current range of fees is from 306 to 650 pounds per week. The actual fee is dependant on the needs of the person and the room occupied. Additional fees are for hairdressing, chiropody, privately funded eye care, outings (with the cost informed in advance) transport for hospital appointments, visitors meals and catering for birthday celebrations with family or friends. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We have collected information toward this key inspection since May 2008. We also received information from the provider and manager on how outcomes for people who use the service are being met and where improvements are planned. Also some data such as the number of people at the home and number of staff. In August we did an unannounced random inspection to look at whether previously made requirements had been met and improvement achieved. There have been safeguarding meetings involving social services and health care providers since November 2007,which concluded October 15 th. Information from those meetings has been used toward this inspection. Care Homes for Older People Page 6 of 29 We sent ten surveys to people who use the service (six were returned) and ten to staff (three were returned). Each could be returned anonymously. We did two unannounced visits to the home. There were 32 people resident at the time. We looked closely at the care of three people, meeting two of them, looking at records and discussing their needs with the manager and staff. We asked the opinion of three health care professionals visiting the home and one who visits occasionally. We met and spoke with two visiting family. We observed a staff meeting. We met and observed staff working. We looked at staff records including recruitment and supervision. We looked at some policies and procedures. People who use the service may be described within this report as clients, service users or residents. What the care home does well: What has improved since the last inspection? What they could do better: Despite many ways information is communicated in the home there is still the need for improvement and this has to be better monitored to guarantee that health care concerns are identified immediately. Care plans need to reflect the true situation at all times and staff must follow those plans. Individual risk should be better assessed and include any potential hazard. All medicines (whether prescribed or not) must be recorded as they enter the home so that a full audit is possible. Where a medicine is to be administered as required or as necessary it must be clearly stated, as part of the plan of care, under what circumstance it may be given. This will better ensure it is given in a consistent way and reduce the likelihood of mishandling. Care Homes for Older People Page 8 of 29 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are only admitted if their needs and wishes are known but individual risks need more attention. Evidence: No people at Ravenscroft receive Intermediate Care. We looked at how people are admitted to Ravenscroft. Five of the six people who completed surveys toward this inspection said they had received a contract and had been provided with enough information about the home to help them make a decision about it. Some added that they had also visited. We saw that written information about the home was available at the reception desk and in peoples rooms. One newly admitted person also confirmed they had visited and chosen their room. They had also been given information about activities in the home. Care Homes for Older People Page 11 of 29 Evidence: We looked in detail at the admission of two people recently admitted. The documents we saw contained information such as next-of-kin, G.P. and photograph as they must. For one there was a professional assessment of the persons needs from the discharging hospital. The homes own assessments were adequately completed and provided a lot of information from which the persons care could be planned. However, where there was possible risk from hazards (medicines in the room and unsupervised bathing) this has not been risk assessed. This had the potential to put them at risk although we believe the risk in the case was minimal. We talked to the deputy manager about how they are able to provide the support people need at the time of admission. He had a sound knowledge of how this would be done. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of health care provision is much improved but remaining weak areas leave the potential for harm. Evidence: We looked at how well peoples personal and health care needs are met. Three people who responded to survey said that they always received the care and support they needed and their medical needs were met, and three said they usually do, one adding: 100 per cent. A visitor said of the care her mother receives: Much better. A social worker, following review visits, said that the home is: Starting to address some existing issues as well as new problems. However, he also reported (on 14 th October) there were still some recording problems which had the potential to put people at risk. The registered manager showed us how recording had improved since the 14 th and said there were currently no pressure sores at the home and all people have their food and fluid needs fully met. We joined a staff meeting where staff were further reminded of the importance of keeping accurate records, without which health Care Homes for Older People Page 13 of 29 Evidence: problems may be missed. We looked closely at the care of two people and less so one other. The care plan of one person had been updated as it should when they were readmitted to the home from hospital. However, on the 13 th August the care plan said: Sore heels. This is an indication that the person might be getting pressure sores to the heels. We looked for any update in their plan to ensure pressure sores did not occur. There was none. Nor was there any record that the heels had been checked again. The care plan of another person said: Stand hourly so as to reduce the likelihood of pressure sores which had been identified as a risk. This instruction was also copied in the staff hand over sheet which is intended to give staff up to date information. The person using the service said they were not standing hourly, there was no record it was happening and two staff providing care since the admission were unaware they should be doing it despite having the hand-over sheet with the information. We found that, as pressure relieving equipment had been provided, pressure sores were less of a risk than at admission. However, the care plan had not been updated with this information. We spoke with four health care professionals who visit the home. Two said it was clear the new manager and deputy have a good level of knowledge and they have much improved the standard of health care at the home. Two others, visiting a newly admitted person, felt unable to express confidence in the way care was delivered. A visiting general practitioner said the care was: Adequate but with several good aspects. We looked at how the home manages medicines. The main store of medicines is secure and records were orderly and clear. Where medicine charts had pre recorded information staff had checked medicines into the home as they must. However, where they were not pre recorded the medicines had not been checked into the home and so a full audit of them was not possible. We visited several rooms and saw medicines in some; in one bronchial mixture, codliver oil tablets and eye drops. Although the person to whom they belonged was mentally able, any risk from this self medication and storage had not been considered within the care planning. Records showed that several people had medicines to be given as required or as necessary. Their use was not part of the persons plan of care so as to ensure that staff would administer them in a consistent way. Care Homes for Older People Page 14 of 29 Evidence: People looked well care for, it was clear that the standard of care delivered is improved and people who use the service are satisfied. We saw that staff were polite to people and knocked before entering their room. However, one person received a telephone call which was directed to a public area for them to take. This was discussed with the manager who said their privacy when on the telephone would be assured in the future. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are helped to lead fulfilled lives. They enjoy the food provided. Evidence: Two people said through survey that there are always activities they can take part in, one said there usually are and three said there sometimes are, one adding: Many are in the afternoon when I am very tired. A monthly newsletter, displayed in the entrance and given to each person who uses the service, gives details of activities and events. This includes a coffee morning and visit from the donkey sanctuary. The second day of our visit we saw some people doing arts and crafts. Peoples assessment now include events of significance (such as family birthdays) and things of importance and interest to them. Where people have not wanted to provide this it is recorded. We were told that future care planning will also include social need and there are plans to have more trips out, cooking sessions and start a gentlemans club. We saw visitors at the home and when people arrive there was a friendly greeting. People are encouraged to make their room their home; some are very individual. Care Homes for Older People Page 16 of 29 Evidence: Choice is somewhat limited where peoples needs are high but where ever possible people decide how to spend their day. We saw one person out walking and another told us she walks on the moor. People said they like the food. There are two choices for each meal and one person told us there is always salad available and when she wants the option of rice they often do this for her. People eat in their room or the dining room as they wish. We saw that many had wine with their lunch and were told this is not unusual. Dietary health care monitoring is now improved and the manager was able to show how that the diet of one person was adequate for them. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are properly managed and people are protected by the homes safeguarding arrangements. Evidence: We looked at how much people are listened to and how the home manages complaints and safeguarding. The homes complaints procedure is well displayed in the entrance hall and was also seen with the information in peoples rooms. The procedure includes the Commissions contact details and says we can be contacted at any stage of a complaint, as it should. The recently appointed manager was well known to visiting family and people who use the service. She is keen to be informed of where improvements can be made. We saw that complaints to the home are now handled effectively and the provider and manager record that nothing will be swept under the carpet. We have not received any recent complaints against the service and the six people who responded to survey said they knew how to make a complaint should they need. Staff records show that staff have received training in how to safeguard the vulnerable adults in their care from abuse and the three who responded to survey said they knew what to do if somebody told them of concerns. Care Homes for Older People Page 18 of 29 Evidence: The home has an easily accessible whistle blowing policy (how to alert any concerns) and it contains the details of who to contact. A recent theft at the home was promptly reported to the police and the Commission. There are no outstanding safeguarding alerts regarding Ravenscroft. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, warm, fresh and properly maintained home. Evidence: The six people who responded to survey said the home is usually clean and fresh and this is what we found the twice we visited. The kitchen was also clean but the cook said this was difficult to keep up with in the time that is available. The home has some pleasant communal spaces and many views over the well tended gardens and the moor. People are able to individualize their rooms as they wish and some are very homely. The two people recently admitted to the home said they liked their rooms; steps had been taken to meet their individual needs and tastes. Furniture and fittings appeared to be in a good state of repair and there is a good standard of decor. We saw no maintenance issues and the manager informed us of plans to improve some exisiting rooms. We spoke to some staff about the standard of equipment available. They said it is satisfactory but would be insufficient if the numbers of people in the home continue to increase. We fed this information back to the manager. Care Homes for Older People Page 20 of 29 Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are properly recruited, trained and in sufficient numbers to meet peoples needs at this time. Evidence: We looked of the effectiveness of the staffing arrangements at the home. People who use the service voiced no concerns about the staff at the home. Two staff who responded to survey said there are usually enough staff to meet the needs of people who use the service and one said there sometimes is. Our first visit staff seemed unhurried and call bells were only heard infrequently. The second visit found staff appearing less calm and unhurried. Staff told us that when agency staff are needed to meet staffing shortfalls the work is more difficult as they do not know people or the building (which is large and complicated). We saw this to be the case our second afternoon at Ravenscroft. The home has a good compliment of support staff at the home. This includes an administrator, housekeeper, maintenance, kitchen, cleaning and laundry staff. The registered provider works from the home and the manager and deputy manager were in addition to the lead nurse during our visits. Care Homes for Older People Page 22 of 29 Evidence: Four staff said their induction to the home covered everything they needed to know and two said it mostly did. A new care assistant, the day of our first visit, was being shown the fire safety arrangements at the home. She told us staff were being helpful in showing her what to do and said senior staff are available to answer questions. Staff feel they are being given sufficient training to do their work. Training includes how to move people safely, first aid, protection of vulnerable adults from abuse and how to prevent pressure sores. We sat in on a staff meeting where the importance of monitoring peoples health was discussed with them. At a random inspection in August care staff were able to tell us how to recognize the first signs of pressure sores. Training is also in place for non care staff. The maintenance worker told us he has been trained in advanced fire safety, moving and handling and safeguarding vulnerable adults. The home reports that more than half the care staff have completed their National Vocational Qualification level 2 or above in care which is an indicator of competence. They add that the majority of the remainder of the staff are signed up for such training, including level 3, an Assessors Award and the Registered Managers Award. We looked at how the home recruits new staff by looking at the records of the last two employed. They contained the necessary checks that the person is safe to work with vulnerable adults. The six staff who completed surveys said that those checks had also been completed before they started employment. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ravenscroft is run with the best interest of people who use the service as a priority. Evidence: The information provided by the manager and provider about the home was informative and told us what we needed to know. 2008 has seen many changes at Ravenscroft including the appointment of a new manager and deputy, both registered nurses. Health and social care professionals consider them to be skilled and knowledgeable. One said to the provider: Two better people to employ you could not have found. On 15 th October social services felt that previous concerns had been addressed to the point where people were safe. The new manager has only been in post since August. She has applied to be registered with the Commission where her fitness to manage will be assessed. Staff describe her as: Firm but fair. They say they now feel protected and better looked after. Care Homes for Older People Page 24 of 29 Evidence: People we met knew the manager and deputy who have both worked hard to restore peoples confidence in the service. In addition, the registered provider does monthly provider visits (although he works on the premises) and asks people their opinion of the home. To get peoples opinion about the home there are meetings for people who use the service, their family and staff. We attended one staff meeting where staff discussed how to make changes toward improving their practice and were given important information. Regular formal supervision of staff work has been started and the provider is continuing a yearly audit of the service through surveying opinion. In light of previous issues relating to standards of health and care provision we asked the manager how she monitors this. She described many informal ways including staff observation and talking to people. However, in light of our findings relating to care planning and communication (please see the standard on health and personal care) there is more need for close monitoring. The provider confirmed that no money belonging to people who use the service is handled within business accounts and any money kept for people is done so securely and with good records kept. We did not look at servicing and maintenance records on this occasion but the home looked well maintained and in a good state of repair. Staff receive the health and safety training they need. However, there needs to be a much broader assessment of individual hazards which might pose a risk to people, such as self administration of medicines and safety when going out alone. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans, and all information which informs staff what care is to be delivered, must be up to date and accurate. So that the needs and wishes of people are met and they are not put at risk. 30/11/2008 2 8 12 (1) Where information 30/11/2008 suggests there is a risk from pressure sores steps must be taken to prevent this. To promote optimum health and welfare. 3 9 13 (2) All medicines received into the home must be recorded. To ensure a full audit is possible so as to protect people. 30/11/2008 4 9 13 (2) Where a medicine is prescribed to be given as required or as necessary details of when it may be 30/11/2008 Care Homes for Older People Page 27 of 29 given must be part of planned care. So that its use is consistent. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 33 There should be a formal, close supervision of the standards of health care delivered by staff, especially regarding the transfer of important information. All potential risks to people should be assessed so that steps can be taken to remove or reduce the risk if necessary. 2 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - 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!