Inspection on 13/06/05 for Redwood Care Centre

This inspection was carried out on 13th June 2005.

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

Redwood Care Centre 26/11/08

Redwood Care Centre 29/08/07

Redwood Care Centre 31/07/06

Redwood Care Centre 28/04/05

Redwood Care Centre 07/10/04

Redwood Care Centre 24/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Redwood Care Centre 179 Epsom Road, Merrow, Guildford, GU1 2QY Lead Inspector Catherine Campbell-Ace Unannounced 13 June 2005 10:00 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. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Redwood Care Centre Address 179 Epsom Road, Merrow, Guildford, Surrey, GU1 2QY 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) 01206 752552 Care UK Community Partnerships Limited Ms Fiona Lawrence CRH Care Home 50 Category(ies) of OP Old age, 50 registration, with number of places Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The age/age range of the persons to be accommodated will be: OVER 65 YEARS OF AGE 2 50 beds providing nursing care for elderly people from the age of 65 years, of which 20 beds may be used for intermediate care. Date of last inspection 28 April 2005 Brief Description of the Service: Redwood Care Centre is owned and operated by Care UK Partnerships Ltd. The service is situated in Merrow, close to the town of Guildford. The service is a ground level building comprising 5 units called Oak, Elm, Birch and Ash. The main concourse is called Maple. The accommodation is arranged in 50 single occupancy bedrooms, 30 for long term nursing care and 20 for delivering intermediate care. There is ample communal and quiet space throughout the premises. The gardens are well maintained with parking places to the front and rear of the premises. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was held over three days and was carried out as a result of a number of serious concerns and complaints to another agency and as part of a Multi Agency Vulnerable Adults Investigation Procedure. The inspectors were Mr J Croft and Mrs C. Campbell-Ace. The inspectors would like to thank the acting manager, operations support manager, service users and staff for assisting them in the inspection. The inspectors examined care plans, supervision files, recruitment files, training files and risk assessments. The inspectors interviewed service users and staff over the three day period. Please refer to the standards examined during this inspection. What the service does well: What has improved since the last inspection? COSHH cupboards were locked at the time of inspection and on the tour of the building, fire doors were observed to be not wedged open. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 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 Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 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) 5 Prospective service users and relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. EVIDENCE: Service users stated that they were invited to visit the home on a trial basis, and were assessed either in their own homes or in hospital. This home does not take emergency admissions. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 9 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 Care plans were found to be incomplete, therefore not providing staff with the information they need to meet the service user’s needs in an informed and safe manner. The home had failed to improve their procedures for administering medication since the last inspection EVIDENCE: Care plans were evidenced and individual care plans were not being followed. Medication assessments were out of date and nursing information was missing. Care plans were seen to have no information regarding social activities and interaction with others. One service user’s plan stated that he liked to sit in the lounge with other service users. The documentation in his care plan stated that he either stayed in bed or sat in his bedroom on his own. The care plans were signed neither by the service user or their family. Monthly weights were not recorded consistently and service users were not referred to the General Practitioner when weight loss was recorded. Not all service users had risk assessments on nutrition. Personal care needs were written in the care plans, including the regularity of bathing. This was recorded as one bath per week, which the service users reported was not satisfactory. Daily records stated, however, that service users were washed. No baths were recorded on these daily records. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 10 The acting manager said that a service user only wants a bath once a week, however, it was evidenced in the care plan that the service user often asks for more baths. Service users were observed to look unkempt and the men were unshaven. Fingernails were observed to be long and faeces filled. Staff interviewed stated that service users fingernails were either cut by relatives or by the chiropodist. The inspectors were informed that it was Care UK’s policy for staff not to cut service users fingernails. Falls risk assessments did not have strategies for service users with high risk of falling neither did risk assessments contain outcomes for service users with high risk of pressure sores. It was observed that some service users had no fluids to drink and some service users were unable to reach their drinks from where they were sitting. One service user stated that she was thirsty and had a jug of water, which was out of reach and no drinking glass in the room. It was noted that one of the bathrooms was cluttered and used as a store for wheelchairs and hoists. Bath temperature recordings were not taken before the baths were used. The medication inspection was conducted by the pharmacist, who made three requirements. Medication Administration Records were examined and it was evidenced that there were a number of handwritten entries written. This had occurred on all units. She evidenced that some MAR forms were signed by staff, some were not signed, some were signed by the GP and others were not signed at all. Receipt of medication records were evidenced to be not completed. Medication crushed for administration via PEG feeding line was evidenced to lack consent from the GP. A risk assessment was on file for crushing of medication for PEG medication, which was written on a falls risk assessment form. One service user had been out of stock of medication from the day before. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 11 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 There was a lack of stimulation for service users. Family and friends were able to visit. Service users choices were limited. EVIDENCE: There were no social activities observed for the service users in the home. There was no evidence of any activities planned. Service users either sat and watched television with others or were alone in their bedrooms, some without any stimulation. One service user requested a television from the inspectors. One relative visited daily to have lunch. Visitors were observed to visit regularly. The meals were observed to be pre packed, pre cooked and in inadequate quantities. The home uses an outside agency for provision of meals. It was observed that service users knew of the menu choice at mealtimes only. Service users stated that menus were not discussed with them. The home uses a four week set rolling menu. The main meal included a choice of three meals, none of which were a vegetarian option. Service users stated that they did not always get their choice, as the most popular choice was on a first come first served basis. Service users stated that if they were the last person to be served, the food was often cold and they were offered the food that was left on Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 12 the trolley. This was observed during the inspection to be mashed potatoes with curry. It was observed that two service users were being assisted with their meals by one member of staff. This was observed to be undignified and disrespectful. Another service user was observed to be eating her meal in bed without appropriate aids. It was observed by the inspectors that service users had communication difficulties with staff members- they could not understand what was being offered to them as a choice of menu. One service user offered what clearly sounded like a ‘lim’. He could not understand what ‘lim’ meant. The staff member actually meant ‘lamb’ One service user requested a small portion of food, however, this request was not met and the portion given was large. Storage of food in the kitchen was found to be inadequate, with uncovered food and a stale cucumber in the fridge. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 13 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) 16,18 There is a satisfactory complaints policy and procedure in place. There was some evidence the procedure was not being followed correctly by staff. The home’s policy and procedure for the protection of vulnerable adults was not implemented. EVIDENCE: The complaints book was viewed and found to be unsatisfactory, as there was no record of chronology of events, nor information on the outcome of each complaint. Hand-written pieces of paper were stapled to the book. The last recorded complaint was on the 13/06/05. Inspectors were informed by the operations support manager that policies were not being followed correctly by the acting manager. Staff discussions evidenced that they knew to whom they could complain, but did not know where to find the complaints policy. Staff had no knowledge of the Whistleblowing policy, but stated that they would talk to the acting manager if necessary. Staff did not know that they could contact the CSCI. It was evidenced that staff had not followed the Multi Agency Vulnerable Adults Procedure when a complaint of abuse had been received. Staff had not attended training in The Protection of Vulnerable Adults. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 14 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) 19,22,23,24,25,26 The cleanliness of the environment was inconsistent. A safety hazard was identified in a service user’s bedroom and service users were unable to call for assistance. Specialist equipment was not made available to service users. EVIDENCE: The hazard identified in a service user’s bedroom was a bell chord wire stretching across the room from the wall. Service users who lacked mobility were unable to summon assistance, as call bells had been placed out of reach. Staff and service users stated there is not enough specialist equipment to meet the service users needs. For example units had to share a hoist between them, which resulted in service users having to wait to use the commode. Inspectors observed that service users were eating in their beds unsupervised, without the necessary aids and equipment to assist them. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 15 Service users reported they were not given the choice of a television or radio in their bedrooms. The bedrooms had the appropriate furniture to meet the standards, but were not homely. Some service users were observed to have family photographs in their bedrooms, but generally, the bedroom walls were bare. The inspectors had to request for one service user’s bedroom to be cleaned and hoovered, as stale food and other debris was seen on the floor. The bedside table was sticky and needed to be wiped over, a discarded curtain was seen on the top of a chest of drawers, unused clinical bags were also seen on this chest of drawers together with a package of pastries. Bath temperatures were not recorded when service users were bathed. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 16 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) 27,28,29,30 There is a satisfactory recruitment policy in place, but practice evidenced that it left service users at risk. The training needs of staff had not been addressed. EVIDENCE: The home employs eleven qualified nurses to cover the 24 hr period. The inspectors observed that there was very little supervision of care staff by these qualified Nurses. Service users personal care needs were not met. Please refer to Standards numbers 7 and 8. Service user’s records were not up to date. Mandatory training had not taken place for staff. Inspectors were provided with evidence that 12 staff were booked on a course for Protection of Vulnerable Adults later in the month. A satisfactory recruitment policy is in place, however, it was evidenced that this policy had not been followed by staff at the home. Staff files evidenced that not all references had been received, including the manager’s files. For example, there was no evidence that references had been authenticated. One member of staff whose reference required investigation, had been employed without evidence being obtained from the previous employer of their suitability to work at the home. This person has been employed for over a year and there were concerns regarding her current practice. Not all staff had references from the last employer. One staff member had no CRB check and no references. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 17 Not all application forms gave the last 7 years employment history. There was no evidence that gaps in employment history had been explored by Care UK. Two members of staff do not have work permits on file. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 31,32,33,35,36,37,38 The management of this home is poor and does not meet minimum standards. Staff are not adequately supervised and Care UK’s policy and procedures are not being followed. EVIDENCE: The acting manager had been in post approximately 4 months. Up to date references were not evidenced in her personnel file. Information requested from the acting manager at the inspection was inaccurate and misleading. Evidence of recordings written by the acting manager of incidents in the home regarding staff members, were unsatisfactory, with dates and signatures missing. The complaints regarding staffing matters were unable to be located. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 19 Please refer to standards 7 and 8 in this report regarding the health and welfare of service users. Service users have their own bank accounts, which are easily accessed. The home has a safe in which to keep service user’s valuables, and receipts were evidenced. Regulation 37 Notifications had not been made within 24 hours of the events occurring, or not at all. Recruitment records were evidenced to be incomplete and policies and procedures were not being followed. Security of the home was poor; Inspectors were let into the home without question. Staff let visitors into the building without asking for identification or asking the reason for the visit. Issues of concern relating to a staff member were identified. The CSCI will be exploring with Care UK their senior management of the home. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION 1 x x 1 1 1 1 1 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 1 1 1 1 x 3 1 1 1 Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 21 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 7 Regulation 12 Requirement The Registered Person must ensure all service users have their personal care needs met, with negotiation, including regular bathing, hairwashing and cutting of fingernails. The Registered Person must en sure male service users are shaved daily unless they request otherwise. The Registered Person must ensure that service users are weighed monthly with their consent and a record kept in their care plan. The Registered Person must en sure that all care plans include social care needs. The Registered Person must en sure care plans are signed by the author and the service user or their representstives. The Registered Person must en sure the care plans contain accurate and up to date information. The Registered person must ensure the smell of cigarette smoke is eliminated from the corridor The Registered Person must en H58 s59510 Redwood v233045 130605 stage 4.doc Timescale for action Immediate 15/06/05 2. 7 12 Immediate 15/06/05 Immediate 15/06/05 3. 7 15 4. 5. 7 7 15 15 15/07/05 15/07/05 6. 7 15 15/07/05 7. 8 13 15/07/05 8. 8 12 1mmediate Page 22 Redwood Care Centre Version 1.30 9. 8 13 10. 8 13 11. 8 12 12. 13. 14. 8 9 8 23 14 12 15. 16. 17. 15 15 15 16 16 12 18. 19. 20. 15 15 15 12 12 12 sure that service users who lose weight are referred to the General Practitioner. via the service user The Registered Person must en sure the falls risk assessments contain strategies for service users at risk The Registered Person must ensure pressure area risk assessments have instructions and outcomes included. The Registered Person must en sure that the service user identified has the urinary drainage catheter changed and the type, size and lot number recorded. The Registered Person must en sure bathrooms are not used as storerooms The Registered Person must ensure medication profiles are updated regularly and signed The Registered Person must en sure all service users have access to drinks and drinking utensils are placed in each bedroom The Registered Person must review the quantities of food provided. The Registered Person must en sure food is not cold when served to service users. The Registered Person must en sure service users are properley supervised when eating meals in bed The Registered Person must en sure food is adequately covered in the fridge. The Registered Person must ensure there is adequate staffing at meal times The Registered Person must en sure service users have the H58 s59510 Redwood v233045 130605 stage 4.doc 15/06/05 15/07/05 15/07/05 Immediate 15/06/05 immediate 15/06/06 15/07/05 Immediate 15/06/05 15/06/05 Immediate 15/06/05 Immediate 15/06/05 Immediate 15/06/05 15/07/05 15/07/05 Redwood Care Centre Version 1.30 Page 23 21. 22. 15 16 16 22 23. 16 21 24. 18 17 25. 16 22 26. 18 18 27. 19 12,23 28. 29. 19 22 13 23 30. 25 12 appropriate aids when eating meals in bed and ensure service users eating in bed are regularly monitored. The Registered Person must review the menus to ensure adequate choice. The Registered Person must find the four missing complaints and forward them to the CSCI Surrey Local Office The Registered Person must en sure that the Complaints Policy is made available and understood by staff. The Registered Person must make sure that the Whistleblowing Policy is available to staff and that they sign and date that they have read and understood it The Registered Person must investigate and refer as appropriate the complaints made by service users of rough handling. The Registered Provider must Make VAP referrals when allegations of abuse of service users is reported. Please refer any retrospective incidents to the CSCI Surrey local Office. The Registered Person must ensure bath temperatures are recorded every time the baths are used. The Registered Person must en sure security of access into the home is improved The Registered Person must make sure that the home has enough equipment, hoists and wheelchairs to meet the needs of the service users. The Registered Person must ensure all call bells are within reach of service users. All call bells must have the length of 15/06/05 immediate 15/06/05 15/07/05 15/06/05 Immediate 15/06/05 15/06/05 immediate 15/06/05 15/07/05 15/07/05 Immediate 15/06/05 Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 24 chord reviewed. 31. 32. 33. 34. 26 26 29 29 23 23 19 19 The Registered Person must en sure all areas are clean and free from the odour of urine. The Registered Person must en sure the bedrooms are cleaned thoroughly, including bed trays. The Registered Person must follow up work permits for two staff members identified. The Registered Person must en sure all staff files contain all as stated in Schedule 2 of The Care Homes Regulations Act as ammended 2001 and ensure that all staff have CRB and POVA clearance before commencing employment Issues regarding references on a staff member identified must be resolved by the Registered Person and the details be sent to the CSCI Surrey Locl Office. The Registered Person must obtain satisfactory explanation, from the staff concerned, the gaps in employment. Written evidence must be provided. The Registered Person must investigate how the acting manager was employed without satisfactory references being obtainedby Care UK. The Registered Person must ensure that all staff have a training update and assessment of recording patient notes. This must include care planning and review and legal issues regarding accurate and timely documentation. This must include completion of accident forms and an update on incident reporting. The Registered Person must ensure all kitchen personnel have appropriate training for H58 s59510 Redwood v233045 130605 stage 4.doc immediate 13/06/05 immediate 13/06/05 15/06/05 15/07/05 35. 29 19 immediate 15/06/05 36. 29 19 15/07/05 37. 29 19 15/07/05 38. 30 18 15/07/05 39. 30 18 15/06/05 Redwood Care Centre Version 1.30 Page 25 their role. 40. 30 18 The Registered Person must ensure all staff attend mandatory training, including VAP training and must review induction, tailored specifically to the operation of individual homes. Specifically nurses should be made aware of how prescriptions are requested or ordered by the doctor, where the prescriptions are delivered to how they are processed and delivered to the local pharmacy. The induction should include the requirements for recording, storing and checking medicines in and out of the home.. The Registered Person must ensure training records are updated. The Registered Person must ensure that service users requests are considered in consultation with service users. The Registered Person must ensure issues around communication and any other matters between staff are resolved. The Registered Person must create local policies as well as corporate policies The Registered Person must ensure all staff receive one to one formal supervision at least 6 times a year, and that it is recorded. The Registered Person must ensure the recording of information is accurate, signed and dated. The Registered Person must ensure the managers follow company policies and procedures. H58 s59510 Redwood v233045 130605 stage 4.doc 15/07/05 41. 42. 30 32 17 12 15/07/05 immediate 15/06/05 immediate 15/06/05 43. 32 10 44. 45. 46. 33 36 10 18 15/08/05 15/07/05 47. 37 10 immediate 15/06/05 15/06/05 48. 37 10 Redwood Care Centre Version 1.30 Page 26 49. 37 37 50. 51. 52. 53. 38 38 33 9 12 12 17 13 54. 9 10,13 55. 8 10,13 The Registered Person must ensure all Regulation 37 notifications are made to the CSCI within 24 hours of the incident. The Registered Person must ensure food in the fridge is covered The Registered Person must ensure all stale foods are disposed of. The Registered Person must ensure all policies are reviewed. The Registered Person must ensure where any changes to medication doses or freqency are suggested and agreed by the GP, the original entry on the MAR chart is discontinued and a new entry signed on the Mar Chart by a doctor. If this change also requires changes to labelling, the doctor should make the changes on the label and sign(initial) and date the changes. The change should also be written in the Medical notes The Registered Person must ensure the visiting specialist nurses such as Macmillan Nurses, Specialist Diabetes Nurses, and Cardiac Nurses leave written instructions for the doctor on specific Multidisciplinary notes and endeavour to speak directly with the GP. It is the responsibility of the specialist nurse to ensure that the doctor receives the recommendations directly The Registered Person must ensure that any specialist visiting a patient signs in a special register which details the patient visited, date and time of the visit and how they were referred. The visiting specialist should also inform the Manager/Deputy immediate 15/06/05 immediate 15/06/05 immediate 15/06/05 15/08/05 Immediate 15/06/05 immediate 13/06/05 immediate 13/06/05 Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 27 56. 9 10 57. 9 13 58. 9 12 59. 9 13 Manager in person that they are on the premises. The Registered Person must ensure that the lack of confidence exhibited by some nursing staff is explored and additional support and training to these members of staff be given. The Registered Person must ensure written authorisation is obtained for the crushing of tablets and the opening of capsules as this makes their use unlicenced and only a medical practitioner can authorise the use of an unlicenced medication. Additionally, the pharmacist should be contacted to ensure the stability of the medication when crushed or opened. The Registered Person must ensure all service users are not left without access to medication prescribed to them by the GP The Registered Person must carry out a risk assessment for all service users who undertake to self administer their own medication immediate 15/ 15/06/05 15/06/05 24/06/05 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 28 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 9 Good Practice Recommendations It is strongly recommended that when it is necessary to handwrite a medication administration record chart in the home that the member of staff writing the chart signs the chart and a second carer checks the entry for accuracy and then initials the chart. In addition the entry should include a reference to where this information was sourced, such as the prescribers name. It is recommended that the staff rota be redesigned in an easier to understand format. 2. 27 Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 29 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Redwood Care Centre H58 s59510 Redwood v233045 130605 stage 4.doc Version 1.30 Page 30 - 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!