Inspection on 28/07/05 for Rawalpindi House

This inspection was carried out on 28th July 2005.

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

Rawalpindi House 14/04/08

Rawalpindi House 04/10/06

Rawalpindi House 13/12/05

Rawalpindi House 09/08/04

Rawalpindi House 22/04/04

Rawalpindi House 10/03/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Rawalpindi House 81 Hermit Road Canning Town London E16 4HR Lead Inspector Sarah Greaves Announced Inspection 28th & 29th July 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. Rawalpindi House Version 1.10 Page 3 SERVICE INFORMATION Name of service Rawalpindi House Address 81 Hermit Road, Canning Town, London E16 4HR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7474 4500 020 7476 2225 London Borough of Newham Care Home 32 Category(ies) of Dementia - over 65 years of age (32), Old Age, registration, with number not falling within any other category (32), of places Physical Disability over 65 years of age (32) Rawalpindi House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th August 2004 Brief Description of the Service: Rawalpindi House is a 32 bedded residential home for older people. The home is owned and managed by Newham Social Services. The premises are on the ground floor and located in Canning Town, within walking distance of the underground station and very close to frequent bus services. The home is divided into four separate units; two of these units are registered for people with dementia. The home offers permanent and respite care. Rawalpindi House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over two days. The inspector spoke to service users, the manager, staff and visitors. Information was also gathered through reading care plans, policies and procedures and other relevant documentation. The inspector joined service users for a meal and observed specific practices, such as the administration of medication. The home completed a preinspection questionnaire and CSCI surveys were received from service users, their representatives and visiting professionals. What the service does well: What has improved since the last inspection? Requirements and recommendations from the previous inspection report have been met in a well- planned manner and the service now has a permanent manager who is known to service users, their representatives and staff through their prior employment at the home. Positive changes have been introduced to the care planning system. The provision of supervision is regular and of a quality to benefit staff and service users. Rawalpindi House Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rawalpindi House Version 1.10 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 Rawalpindi House Version 1.10 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) 1,2,5 and 6. Prospective service users and their representatives are provided with clear information about the home and encouraged to visit before admission. Contracts are provided to permanent service users. Intermediate care could not be assessed at this inspection visit. EVIDENCE: The inspector looked at the home’s Statement of Purpose and Service Users Guide. The Statement of Purpose (SOP) was written in accordance to Schedule 1 of the Care Homes Regulations; however, references to the former registration authority (Newham Social Services Registration and Inspection Unit) were noted in two documents within the SOP. It was also found that the information regarding to the home’s management of complaints in the SOP did not clearly identify the role of the Commission for Social Care Inspection. The Service Users Guide was well written and presented in a ‘user-friendly’ style; this document did explain that service users and/or their representatives could refer a complaint to the Commission. Contracts were available for viewing by the inspector. Rawalpindi House Version 1.10 Page 9 Via discussion with the manager, it was noted that many of the permanent service users had become familiar with the home through previous respite care placements. The inspector was shown a new protocol for the admission of service users for respite stays, which included a letter inviting service users and their representatives to look around the home prior to their first stay. The manager is advised to maintain a record within all new service users files (applicable to permanent and respite service users) to document whether they received a pre-admission visit. It is acknowledged that invitations to visit may be declined by individuals and this should also be documented. The home offers placements to respond to very urgent situations in which it is not feasible to offer a pre-visit. The inspector discussed the provision of intermediate care at the previous inspection visit. It was then concluded that the home did not provide an ongoing intermediate care model involving the input of rehabilitation staff (occupational therapists and physiotherapists). At this inspection visit it was established that the home could provide this kind of service, subject to an appropriate multi-disciplinary care plan and the input/advice of external health care staff. One of the staff had received training in implementing intermediate care. The inspector was not able to assess the home’s capability to provide this service since none of the service users at the time of this inspection was receiving intermediate care nor had there been any recent recipients of this service. The manager is requested to inform the inspector of any service users admitted for intermediate care to enable arrangements for the CSCI to fully assess Standard 6. Standards 3 and 4 were not assessed at this inspection visit and will be assessed at the next (unannounced) inspection. Rawalpindi House Version 1.10 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 and 11. The care planning is good and written in a clearly presented style, which is accessible to service users (depending on their cognitive abilities), their representatives and visiting professionals. The health care needs of service users are satisfactorily met. The home’ s current attention towards dementia care training should impact upon the development of more socially orientated information within the care plans, subject to the wishes of individual service users and their representatives. Some requirements and recommendations have been issued relating to dealing with medications. The individual rights of service users are met in a respectful and caring manner. The home demonstrated safe and sensitive practices for supporting service users who are dying, taking into account the home’s registration as a residential care establishment. EVIDENCE: The inspector looked at six care plans. The care plans comprised of a general assessment of needs, specific guidance/ plans of care to meet identified needs and a risk assessment. The care plans were presented in a straight- forward, concise and logical style. Potential and actual risk factors were identified at the assessment stage, addressed in the care plans and further detailed in the designated risk assessments. Although the care plans demonstrated an Rawalpindi House Version 1.10 Page 11 individualised approach to meeting the assessed needs of service users, it was noted that ‘social information’ such as the former occupation of service users, their family composition and past and present hobbies was quite brief. Staff told the inspector that service users sometimes choose not to talk about their past and this choice is respected. All of the care plans viewed by the inspector were up-to-date; however, one of the risk assessments had not been reviewed as planned in May 2005. The inspector was informed that staff are vigilant in contacting the service users social workers to ensure that annual statutory reviews are conducted when required. Auditing of the care plans is undertaken by the home’s officer staff. The inspector suggested that the manager should also audit a few care plans every month as part of their quality assurance exercises. This is a recommendation for good practice rather than a requirement as the care plans met the National Minimum Standard. The information received by the inspector from visiting health care professionals did not indicate any concerns with the home’s ability to manage the health care needs of service users. Service users are escorted to hospital appointments and visited by staff if they require admission. The inspector read one complaint relating to the health care support received by a former service user; further information regarding this complaint has been recorded in Standard 16 of this report. The care plans read by the inspector demonstrated a satisfactory approach to understanding and meeting health care needs within a residential setting. The inspector looked at the storage of medications, checked medication administration records and watched a member of staff administer medications. The medications are given by senior staff, who have received training from a pharmacist. The following observations were made: 1. Topical lotions and creams are stored in service users rooms. These prescribed medications are not kept in a lockable drawer but are stored in a wardrobe or a container above a wardrobe. Some of the lotions and creams are moisturising products which can be purchased ‘over the counter’ from pharmacies; however, one of the topical creams was noted to contain steroids and could be harmful if found by other persons (for example, a service user with dementia or a visiting child). The home must seek guidance from the dispensing pharmacist as to which topical medications must be retained within the medication trolley. 2. One service user had over three months supply of a topical lotion stored in their wardrobe. Robust arrangements for returning to the pharmacist all medications not required must be adhered to. 3. The pharmacy labels on some of the topical creams and lotions stated ‘apply as care plan’. The same information was also written on the medication administration records. The care plans viewed by the inspector did not contain instructions for the use of these topical medications. The home must establish Rawalpindi House Version 1.10 Page 12 a consistent system with the pharmacist so that the medication labels specifically state details of application, or alternatively this information must be entered in the care plans. 4. Medication was signed for before it was given to a service user. 5. A service user was not observed to check that they had taken their medication. 6. The medication administration charts for respite service users are written by senior staff. Insufficient information was recorded on these charts for service users prescribed aspirin (whether it is a tablet for dispersal in water or if it is a coated tablet that can be swallowed). This must be addressed by staff with a responsibility for writing the medication charts for respite service users. 7. Some of the medications were prescribed for administration at bedtime but were given at suppertime as specific service users requested to retire to bed earlier. The home must notify the General Practitioner so that these medications are actually prescribed at suppertime. These findings indicated that senior staff would benefit from refresher medication training. Through discussions with service users and via direct and indirect observations, the inspector found that service users were spoken to and supported in a dignified, reassuring and respectful manner. Service users commented very positively about the staff; one of the service users stated that staff always spent time talking to her if she felt sad about bereavements in her life. Based on this inspection visit and previous inspection visits, the inspector found that staff responded in a professional and friendly manner to meet the needs of service users who enjoyed a joke and ‘humorous banter’. The inspector looked at the home’s policy for ‘Death and Dying’, which was satisfactorily written. Via reading of the policy and discussions with the manager and staff, it was noted that the home liaised with the General Practitioner and the representatives of service users in order to establish if the needs of a service user who is dying could be met at the home or whether their medical condition necessitated an admission to hospital; this process would strive to take into account any expressed preferences of service users. Rawalpindi House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 Very good progress has been achieved with the provision of activities and the promotion of links with the local community. Standard 13 has been commended for exceeding the National Minimum Standard, partly due to the considerable efforts to promote service users involvement with people from local churches, arts, music and a leading reminiscence therapy organisation. It is hoped that some of the staff will be organising reminiscence activities by the time of the next inspection visit. The staff training (in reminiscence and related dementia care issues) should enable the home to demonstrate very good developments in relation to the outcomes of Standard 12. The promotion of service users choices and the food service is good. EVIDENCE: At the time of the inspection, four of the service users attended day centres in the community. One of the service users went to a luncheon club that met their identified cultural needs. The home has previously offered service users opportunities to meet their spiritual needs; however, it was noted at this inspection visit that some very good links had been arranged with local churches and the programme of ecumenical worship was varied, including a participatory service with music. The weekly activities within the home included arts and crafts, sing-a-long with a visiting musician, bingo, exercise to music and reminiscence. An external Rawalpindi House Version 1.10 Page 14 arts teacher provided the arts and crafts sessions twice a week and recent artwork was displayed in the communal lounge. A representative from the Age Exchange reminiscence organisation facilitated the reminiscence sessions. The inspector was informed that seven of the staff had undertaken training with Age Exchange with an eventual objective to lead their own reminiscence activities within the home. Outings had taken place to seaside resorts and there was a programme of internal entertainments such as a St. Patrick’s Day Ceildh (Irish dancing display), an Easter bonnets party, karaoke and VE Day celebrations. The summer activities schedule also included a picnic and a barbeque. Flexible visiting for the families and friends of service users was offered. The home was in the process of trying to set up a service users and representatives forum that would be convened by an independent advocate. Previous attempts to establish this group had been postponed due to a lack of local advocacy resources; however, the manager was due to meet with Age Concern soon after this inspection visit. The inspector was shown evidence of previous consultation with service users and their representatives regarding their interest in this proposed group. Observations during the inspection demonstrated that service users were used to determining their own routine, for example, whether they wished to remain in their own unit after supper or spend time in the large communal room and advising staff as to when they needed assistance to prepare for bed. The inspector joined service users for lunch on the second day of the inspection. The menu plan offered a good and varied choice of food items. Two varieties of fish were available for the Friday lunch; however, an alternative to fish was also offered. A selection of fresh fruit was readily available on all of the units; separate storage of the bananas is suggested to prevent overripening of the other fruits. Meals were served in a dignified manner. The inspector observed that a television was switched on during supper on one of the units, although all of the service users were in an adjacent dining room area at the time and could not view the television. Generally, noise levels were well controlled, recognising the negative impact of unnecessary stimuli for older people with dementia and/or hearing impairments. One of the units for people with dementia played remarkably relaxing and calming music for the service users with dementia; the manager was advised to obtain this music for other service users who may benefit from this sensory input. Rawalpindi House Version 1.10 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 and 18 Complaints are taken seriously and thoroughly investigated. The rights of service users are upheld, and they are protected from abuse through a robust procedure and staff training. EVIDENCE: As previously stated, the complaints procedure made available to service users and their representatives in the Service User Guide was comprehensive. The home had received one complaint since the last inspection, which was investigated via the Newham Council Customer Relations Team. The inspector read the complaint investigation report, which was thorough and fair. The home had implemented strategies to prevent a further re-occurrence of the areas of practice acknowledged to have not met the standards of care expected by service users and their representatives. Service users are supported to meet their legal and civic entitlements, for example to vote or conduct a private meeting with a solicitor at the premises. The home used the Newham Social Services Adult Protection procedures and the Adult Protection Co-ordinator provided training for staff last year. The inspector would anticipate that this training is repeated at regular intervals to enable staff to maintain and up-date their knowledge. Rawalpindi House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24,25 and 26 The manager had identified improvements to the premises, inclusive of the garden, and funding had been sought from the registered provider (the council). The premises were generally well maintained, clean and homely, although the communal toilets would benefit from some decorative effects. EVIDENCE: The home comprises of four separate units, each with en-suite bedrooms, a lounge/ dining area and communal bathrooms. The manager stated that the large communal room in the centre of the premises was due to be refurbished. This room is also the home of the service’s two pet budgies. At the time of the inspection, the external grounds needed some development in order to provide a pleasant area for relaxation and outdoor activities; this was being addressed by the home. The inspector noted that some of the communal toilets needed to be made more ‘homely’, possibly with wall motifs, small pictures or colourful tiles; they were otherwise clean, painted in pastel colours and suitably equipped. Many of the service users did not use these facilities since they have an en-suite toilet in their bedrooms. Rawalpindi House Version 1.10 Page 17 The inspector was invited by some of the service users to view their bedrooms. These rooms were tastefully decorated and could be personalised with ornaments, pictures and small items of furniture. The inspector checked the availability of hot water during the day and evening; this was found to be satisfactory. Testing of the home’s emergency lighting system was conducted by the service. The home was clean, hygienic and free from any offensive odours. Standard 22 was not assessed at this inspection visit and will be assessed at the next (unannounced) inspection. Rawalpindi House Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 and 30 Service users receive care from a sufficient number of staff at each shift. The home had met the National Minimum Standard for at least 50 of the current care staff to possess an NVQ level 2 qualification in care by December 2005, and officer grade staff are also well qualified. Standard 30 has been commended as the actual and proposed training for staff exceeds the recommended minimum of three days per year and has been sourced from accredited and knowledgeable training organisations. EVIDENCE: The staffing levels enabled staff to provide a good standard of care and to undertake small group activities. On the second day of the inspection, a small group of service users visited a nearby community centre for afternoon tea with staff escorts. The management team comprised of the manager, three officers and one ‘acting up’ officer, which meant that a senior and experienced person always manages the home. The officers were provided with NVQ level 4 management training, which exceeds the National Minimum Standard for the training of staff at their designated grade. The attainment of NVQ level 2 qualifications for care staff was also very good. The inspector looked at the staff training profiles, which evidenced that staff received mandatory training (inclusive of induction/foundation courses) and additional training relevant to the needs of the service users. Some of the staff are due to commence a dementia training course in October 2005, provided by an external dementia care trainer approved by the Alzheimer’s Society. This Rawalpindi House Version 1.10 Page 19 course was of a significantly longer duration and depth than ordinarily provided within this care sector. The personnel files for staff are held at the council’s Human Resources department and were not inspected on this occasion (Standard 29). A check upon these files will be undertaken following the next (unannounced) inspection. The inspector was concerned that the home had identified that approximately eight members of staff did not possess Criminal Record Bureau checks. A requirement has not been issued in this inspection report as the home was actively and openly addressing this concern; however, this will be rigorously monitored at the next inspection. Rawalpindi House Version 1.10 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 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) 31,32,36,37 and 38 The manager is experienced and competent in their role. A good improvement was noted with the delivery of staff supervision. Good systems for sharing information were observed during the inspection but the home needs to increase staff attendance at designated staff meetings. A requirement has been issued relating to the storage of care plans. The general management of the home’s health and safety responsibilities was satisfactory; however, further attention must be applied to ensuring that all first aid equipment is valid and specific cleaning fluids are not left unattended. EVIDENCE: The manager was appointed earlier this year, having had substantial experience of being an ‘acting’ manager and deputy. The manager’s professional background includes general and mental health nursing, with a post- qualification nursing certificate in the care needs of older people. The process for the manager to be assessed for ‘registered manager’ status by the Rawalpindi House Version 1.10 Page 21 CSCI has commenced. The inspector was very satisfied with the home’s management and was pleased to note a very good response to the issues addressed via requirements and recommendations in the previous inspection report. The introduction of a detailed dementia training course for care staff has been commented upon in this report; the inspector noted that Newham Social Services also offered training courses suitable for the continuous professional development of qualified social work/ social care management staff, such as dementia care. The inspector observed the ‘hand-over’ between morning and afternoon staff; the manager’s approach at this hand-over encouraged people to demonstrate their responsibilities as care staff, whilst ensuring that appropriate management guidance was given regarding acute issues raised (such as a service user’s health care needs related to diabetes). As well as the ‘hand-over’ meetings, information is shared at staff meetings. The inspector noted that the low attendance at staff meetings needs to be addressed by the service. The supervision records demonstrated a good improvement in the home’s compliance with providing at least six formal supervision sessions to all staff per annum. The records evidenced that staff had received two or three supervisions since January 2005, as well as a training needs appraisal. The supervision records indicated that the quality of the supervision was focused and relevant for individuals. The inspector observed that care plans were kept in drawers on the units and transferred to a cabinet overnight. The Care Homes Regulations require that personnel information relating to service users is kept securely. Whilst acknowledging that the care plans appeared to be safely stored during the duration of this inspection visit, the potential remains for unauthorised persons to access unlocked drawers and cabinets. Other confidential information is stored in lockable cabinets in the administrative office. The following health and safety checks were made and found to be satisfactory: 1. Refrigerator and freezer temperatures 2. Portable electrical appliances testing 3. Regular fire drills 4. Training of a sufficient number of staff for first aid and fire warden responsibilities 5.Electrical installations check by a competent person 6. Weekly fire alarm points testing and 7. Professional maintenance of fire equipment. The inspector checked the first aid box on one of the units and found one item that had expired. Evidence was presented to demonstrate that the first aid boxes are checked by staff on a regular basis but due to the feint markings with expiry dates on some first aid products, it is advised that these checks are undertaken by two staff. It was also observed that a trolley with cleaning fluids including bleach was left unattended for a couple of minutes at the entrance to one of the units. Rawalpindi House Version 1.10 Page 22 The inspector looked at the home’s accident book. The manager explained that a policy has been introduced since the last inspection that now requires staff to complete this record book if, for example, a fall is due to faulty equipment but not if a service user falls due to vertigo. The manager stated that they kept a record of all accidents irrespective of the cause. Standards 33, 34 and 35 were not inspected at this inspection visit and will be inspected at the next (unannounced) inspection. Rawalpindi House Version 1.10 Page 23 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 x x x 3 2 2 Rawalpindi House Version 1.10 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Requirement The Registered Person must ensure that the issues raised relating to medication within the main body of this report are addressed. The Registered Person must ensure that staff with a responsibility for dealing with medication receive refresher medication training. The Registered Person must ensure that the garden area is improved and furnished with sufficient external seats and tables, including canopies for sun/wind protection.Subject to the canvassing of service users wishes,the creation of raised planting areas should be considered to enable service users to tend to plants or pick flowers. The Registered Person must ensure that care plans are stored in lockable facilities when not in use. The Registered Person must ensure that the equipment in the first aid boxes is safely maintained. The Registered Person must Version 1.10 Timescale for action 30/09/05 2. 9 13(2) and 18 (1) 15/10/05 3. 19 23(2) g and o 30/11/05 4. 37 17(1) 30/09/05 5. 38 13(4) c 30/09/05 6. 38 13(4) a 31/08/05 Page 25 Rawalpindi House ensure that hazardous substances are kept securely at all times. 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 1 Good Practice Recommendations References to the former registration and inspection authority should be removed from documents within the Statement of Purpose and the information relating to the CSCIs role for complaints should be consistent with the information provided in the Service User Guide. The manager should keep a record of whether service users and their representatives have visited the home prior to admission,and whether an invitation to visit has been declined. The care plans should contain more social history and social needs information.It is acknowledged that some service users and/or their representatives may not wish to provide specific information-this should be recorded within the care plan. Staff who have received training in reminiscence therapy should commence reminiscence activities, with initial support from the external facilitator and/or the manager in order to develop their confidence in this practice, if necessary. The communal toilets should be made more homely . The home should investigate methods to increase staff attendance at team meetings. The manager should audit a sample of the care plans every month. 2. 5 3. 7 4. 12 5. 6. 7. 22 32 32 Rawalpindi House Version 1.10 Page 26 Commission for Social Care Inspection Gredley House 1-11 Broadway London E15 4BQ 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 Rawalpindi House Version 1.10 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. 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