Inspection on 23/05/05 for Rock House

This inspection was carried out on 23rd May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rock House 27/07/07

Rock House 07/06/06

Rock House 21/10/05

Rock House 11/10/04

Rock House 04/05/04

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Rock House Austenwood Lane Chalfont St Peter Bucks SL9 9DF Lead Inspector Joan Browne Mike Murphy Unannounced 23 May 05 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. Rock House Version 1.10 Page 3 SERVICE INFORMATION Name of service Rock House Address Austenwood Lane, Chalfont St Peter, Bucks SL9 9DF 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) 01753 882194 Gold Hill Housing Association Susan Shadloo Care Home 37 Category(ies) of Old Age, (OP) not falling within any other registration, with number category of places Rock House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th October 2005 Brief Description of the Service: Rock House is a care home for older people, which provides personal care and accommodation for thirty-seven service users who are elderly, physically and mentally frail. Gold Hill Housing Association owns the home, which is a public limited company. The home is located in Chalfont St Peter, at the top of Gold Hill Common. It is close to shops, pubs, the post office and other amenities. Rock House was developed from two large semi-detached houses and consists of three floors. Access to floors is via a passenger lift. All the home’s bedrooms are single and twelve of the bedrooms have en suite facilities. The home has its own pleasant landscaped garden. Rock House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home, which took place on the 23rd May 2005 from 10.00 am to 4.30 pm. The lead inspector was Ms Joan Browne who was accompanied by Mr Mike Murphy (Inspector). The inspection consisted of meeting with residents, examination of care documentation and records. A tour of the communal areas, general kitchen and some bedrooms was carried out. The serving of lunch was observed. The inspectors fed back to the chief executive, the registered manager, and the project manager the out-come of the findings of the inspection. What the service does well: What has improved since the last inspection? Rock House Version 1.10 Page 6 Since the last inspection the manager carried out a service user’s survey. The outcome of which has affected how meals are served and presented at lunchtime. Residents are now able to serve their own vegetables. There has been a change in the dining area facility for the more able residents. The home has reviewed its medication policy to incorporate a homely medication procedure. A list of staff names who administer medication with their signatures is now kept in the medication folder. Training for staff in the protection of vulnerable adults and abuse awareness has been facilitated. The complaints folder has been developed further to comply with data protection legislation. 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. Rock 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 Rock 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 and 3 The home’s combined Statement of Purpose and Service User’s Guide does not provide sufficient information to enable prospective residents to be clear about the services the home provides. There is room for improvement and consistency in the standard of recording assessments to ensure that residents’ care needs are fully met. EVIDENCE: Rock House Version 1.10 Page 9 The ‘Statement of Purpose and Service Users’ Guide’ are combined in one brochure style document. The Statement of Purpose is required to include the information listed in Schedule 1 of Regulation 4(1)(c). The Service Users Guide should include the information listed in standard 1.2. Previous versions have failed to fully conform to the Schedule and the standard and the responsible individual and registered manager were required to address this on earlier inspections. Inspectors were given a copy of the current version of the brochure and it is noted that no changes have been made since the last inspection. The document includes reference to the additional support, which is available through the ‘Gold Team’ (a separate registered domiciliary care service also run by the housing association) at extra cost. The document gives the numbers but not the sizes of rooms, on the first page the number of places are correctly stated as 37 (‘in mainly single accommodation’) while on the last page the document states that there are 36 rooms, reference to the complaints procedure is potentially misleading in not making it clear that residents may refer a complaint to The Commission for Social Care Inspection at any stage of a complaint. The document does not make it clear that the ‘care manager’ is now the registered manager. Assessment and care planning documents are based on the Standex care planning system. This has a comprehensive assessment section. Five care plans were examined. The standard of recording assessments varied. Two were well completed – comprehensive, detailed and regularly reviewed and updated. In all cases the tissue viability risk assessment was well completed. Weights were regularly recorded on all forms examined. However, omissions were noted in three other assessments, which compromised the quality of the assessments. For example, the sections on manual handling and on mental health were not fully completed. It was noted that ‘tippex’ was used in three care plans - this is contrary to good practice. Assessment documentation included a form for calculating nursing input but this should be determined by National Health Service registered nurses as outlined in standard 3.5 (of the National Minimum Standards (NMS) for Care Homes for Older People). Rock 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, 9 & 10 Care plans lacked sufficient information to enable staff to meet residents’ health, personal and social care needs fully. Current practice with regard to administration and recording of medication does not conform to good practice guidelines as outlined by the Royal Pharmaceutical Guidelines. This increases the risk of errors in the administration of medicine and could have potential adverse consequences for residents. EVIDENCE: Five care plans were examined. The system of care planning used in the home includes section for recording a comprehensive assessment of needs. Standards of care planning were found to vary reflecting standards of assessment. Some were based on good assessments and had good care plans to meet identified needs. Others lacked detail, some sections had either not been completed or were completed inaccurately (examples were discussed with the registered manager towards the end of the inspection). Daily reports tended to record only physical aspects of care. All care plans were reviewed monthly. It was difficult to assess the level of service user involvement in the process. Rock House Version 1.10 Page 11 The home has the Manrex monitored dosage medication system in place. The inspectors examined the home’s medication policy. The document appeared detailed however, there are instances where it refers to ‘nurse in charge and first level nurse’. This information appeared contrary and should be removed, as the home does not provide nursing care. A homely medication policy had been developed. It was noted that the new medication cycle commenced on the day of the inspection. Therefore, the medication administration record (MAR) sheets for the previous cycle were examined. The inspectors were disappointed to note gaps on the MAR sheets and were concerned that there was a gap noted on a particular day for the administration of Insulin to a resident. Some entries were scribbled over and hand written entries did not have a second staff member signature. Amendments to the frequency and dosage of some medication were noted but there was no written evidence of a doctor’s signature or a note to confirm that amendments were authorised by the general practitioner. It was noted on one MAR sheet for a particular resident that a particular medication was prescribed to be administered on alternate days. However, in one instance the MAR sheet reflected that the medication was administered on consecutive days. There was no written record why this had occurred. The controlled medication record register was checked. Two residents were prescribed for MST, which is an analgesic. However, in one particular entry only one staff member signature was recorded. Also the balances recorded in the register did not correspond to the tablets in the packets. Eye drops opened were not dated. The storage trolley was in need of cleaning. The manager must ensure that staff record and administer medication in accordance with the Royal Pharmaceutical Guidelines. Regular monitoring of MAR sheets must be carried out and staff competencies assessed. Evidence of monitoring and competency assessments undertaken must be kept for inspection purposes. Handwritten entries recorded on the MAR sheets should be entered by two staff members signed and dated. The manager should ensure that amendments to residents’ medication are recorded on the MAR sheet by the general practitioner. As a good practice it is being recommended that Nitrazepam, which is a hypnotic (sleeping tablet) should be treated as if it were a schedule drug and be administered by two staff members. Protocols should be developed for the administration of Fosamax and insulin. The inspectors were told that work was in progress to develop a treatment room where residents could be seen and examined by the general practitioner and district nurse in private. To date there has not been any further development in improving the telephone facility so that residents could receive and make calls in private. Service users preferred term of address was recorded in their care plans. Rock House Version 1.10 Page 12 Rock 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) 15 Meal times need to be better managed to ensure that residents’ preferences and dietary needs are catered for. The arrangements in place for the disposal of waste food were institutionalised and spoiled the ambience of the mealtime. EVIDENCE: The lead inspector observed lunch being served. Not all tables were appropriately set with tablecloths, napkins and condiments. Choices displayed on the menu were as follows: egg, chips and ham, with bread and butter. Salad was the second choice however, it appeared that none of the residents wished to have the second choice. The menu for the day included bread and butter. However, this was not offered on the day. Inspectors were pleased to note that residents were able to help themselves to chips. However, those residents who required assistance with feeding and had difficulty with swallowing were not offered an alternative. Staff were seen mashing the chips ham and eggs. As a result not all residents were able to eat their lunch. The manager is required to ensure that the kitchen staff provide an alternative choice for those residents who require a soft diet when chips, ham and eggs is on the menu. There was not a lot of interaction amongst residents during lunch. Staff were seen disposing of waste food in the dining room in a plastic container, which gave the process an institutionalised feel. It is recommended that the manager review this practice. Rock House Version 1.10 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The review of the home’s complaint folder has ensured that more detailed information relating to complaints made by residents, relatives and stakeholders is now available with outcomes. Staff have had training in adult protection and abuse aware. With ongoing training and clear guidelines this should ensure that residents are protected from any potential abuse. EVIDENCE: The inspectors are pleased to report that the manager has reviewed the complaints folder. Complaints are now being recorded on individual sheets to comply with data protection legislation. One minor detail omitted on the sheet was the date. The inspectors are confident that this would be amended. It is recommended that the manager record all verbal concerns and complaints and action taken. The inspectors are pleased to report that the manager has acquired a copy of the Buckinghamshire County Council adult protection policy. Training in adult protection and abuse awareness has been cascaded down to staff. A copy of the learning pack was made available to the inspectors. Rock House Version 1.10 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 22, 24, 25, 26 A clear record maintenance system is not in place to ensure that the environment for resident is safe and well maintained. Furnishings were showing signs of wear and tear and could potentially compromise on residents’ comfort and safety. Temperatures in some hot water taps in bathrooms and toilets exceeded current regulated guidelines and could potentially pose a safety risk to residents. The home has adaptations and aids to meet the needs of the frail residents. This could be further improved by fitting a support frame to the toilet on the ground floor and making the call bell more accessible to meet the needs of residents on this floor. Overall residents’ bedrooms examined appeared homely and personalised. However, two bedrooms posed health and safety problems to the residents occupying them. The standard of hygiene in the communal areas in the home was good which indicated that resident’s well being was being met. Rock House Version 1.10 Page 16 EVIDENCE: The home is located on three floors. Access to floors is via a passenger lift and stairs. Routine maintenance work is carried out by the home’s maintenance operative. Improvement in entries recorded in the maintenance record book is required to ensure that all maintenance work identified as needing attention is carried out. Information recorded in the maintenance book should be legible, kept up to date and clearly signed off when work has been completed. The home has three main lounges, which are smoke free. The standard of lighting was satisfactory. However, furnishings were showing signs of wear and tear. Cushion covers in one armchair in the South wing unit needed replacing and others were in need of washing. The home has adequate numbers of bathrooms and toilets. Hot water temperatures in toilets and bathrooms were checked and some temperatures exceeded 43 degrees Celsius. Ranging from 45 degrees Celsius to 50 degrees Celsius. The flow of water in some hot taps appeared slow. A requirement is being made to have restrictor valves on taps repaired or replaced and the flow of water in taps adjusted. Residents have access to all parts of the communal and private areas with the use of the passenger lift. Some bathrooms are fitted with hoists. Portable hoists are available to assist staff with moving and handling residents. Handrails are fitted in the corridor to support service users. Call bells are fitted in residents’ bedrooms and lounge areas. It was noted that in one particular toilet a support frame was required and the call bell needed to be respositioned so that it was accessible to residents. The inspectors examined some bedrooms at random. They appeared homely and personalised with family pictures and mementoes. It was noted that in some bedrooms standing radiators were in place. Appropriate risk assessments were in place. In one particular bedroom an electrical adaptor was in place with more than two electrical plugs in situ and posed a safety risk. The manager is required to risk assess the electrical adaptor. In one particular bedroom there was a strong smell of odour. The manager must ensure that the odour is eliminated or replace the floor covering. Emergency lighting is provided throughout the home. Table lamps are provided in some bedrooms. On the day of the inspection water temperatures in some regulated outlets were found not to be compliant with the regulation. The manager must ensure that valves are adjusted in order to conform to the standard. Rock House Version 1.10 Page 17 The laundry room is situated away from where food is stored prepared and cooked. Washing machines are equipped with the specified programming to meet disinfection standards. Walls and floor in the laundry room were being maintained. Adequate hand washing facilities were available. Communal areas on the day of the inspection were free from offensive odours. Rock 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, 29, 30 The staff skill mix has not changed since the last inspection, which has ensured that the care provided to residents, has been consistent. The home’s recruitment procedure is not robust and do not provide the necessary safeguards to protect the residents. EVIDENCE: The staff establishment and skill mix have not changed since the last announced inspection. Inspectors were informed by the chief executive (the Responsible Individual) and the registered manager that the home is now a National Vocational Qualification (NVQ) training centre and thus able to avoid delays it has encountered with other training providers to date. According to information supplied by the home four staff have been awarded NVQ 2 in direct care and five are currently working towards it, Two staff have been awarded NVQ 3 in direct care and two are working towards it, and one staff member is working towards NVQ 4 (the registered manager and chief executive already have NVQ 4). Five staff records were inspected. Four records related to staff starting after July 26 2004 and one record to a staff member who started before that date. The information on file was compared against that required under Schedule 2 of Regulations 7, 9 and 19 (as listed in the third edition of the NMS for Older People) and amended after the introduction of Protection of Vulnerable Adult (POVA) on July 26 2004 (as listed in annex c to the Department of Health practical guide to POVA). Rock House Version 1.10 Page 19 The standard of filing had improved considerably since the last inspection but the content of files varied. Applicants are required to complete an application form. One application gave no details of previous experience in care although information elsewhere on the persons file indicated that the applicant had had significant experience in care. In some cases it was unclear whether references were from a former employer or were personal. These points were not noted in the record of interview. A ‘POVA first’ check was not on file (as required for staff appointed after 26 July 2004 pending the Criminal Record Bureau (CRB) disclosure) and could not be located by the close of the inspection. The chief executive assured inspectors that these had been obtained for staff before they commenced work. Three of the five files examined did not contain details of induction. One record listed the content of the induction programme. This included moving & handling, medication, infection control and ‘emergency treatments’. This programme was carried out in January and February 2005 and the person was assessed as competent in March 2005. A copy of the training programme from December 2003 to April 2005 was given to the inspectors. Rock 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) 38 To ensure that residents well being and safety is not compromised, the home’s health and safety procedures need to be strengthened. EVIDENCE: The fire record log was examined and it was noted that there had been an improvement in its presentation. Loose sheets had been re-enforced and filed in a systematic order. All fire zones appeared to be regularly activated however, some gaps were noted in the weekly tests. List of staff names were recorded but it was not clear if staff members’ names listed had participated in a fire drill or were present at the weekly test. There was no evidence to substantiate if night staff undergo regular fire drills. The manager must ensure that night staff participate in a minimum of two fire drills yearly and a tabletop exercise evacuation. Food temperature records and freezer temperatures are recorded daily. The manager must ensure that opened sauces stored in the refrigerator are labelled and dated to avoid food contamination. Rock House Version 1.10 Page 21 A record is kept of all accidents sustained by service users. Information recorded in the accident book relating to injuries sustained by residents was not sufficiently clear and detailed. It is recommended that the manager should audit the content of the accident book to ensure that information is clear and detailed. It was noted that Control of Substances Hazardous to Health (COSHH) cleaning solutions were stored on shelves in the laundry room. The inspectors were told that the laundry room is kept locked when not in use. However, the practice appears to be in breach of the COSHH regulation and posed a safety hazard. The manager must ensure that all cleaning materials are locked in a cupboard. It was noted that the use of support rails was in place on some residents’ beds. It is required that the manager develops a generic risk assessment for the use of rails. Rock House Version 1.10 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 2 2 2 x 2 2 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 2 Rock House Version 1.10 Page 23 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 1 Regulation 4(1) Requirement The registered manager must ensure that the combined Statement of Purpose and Service Users Guide document covers all the information required under Schedule 1 of the Care Homes Regulation. (Previous time scale of 31.01.03 not met.) The registered manager must ensure that staff undergo training in care planning and report writing which should be ongoing. (Previous timescale of 31.01.05 not met.) The registered manager must monitor care plans on a regular basis. (Previous timescale of 31.01.05 not met) The registered manager must ensure that staff record and adminster medication in accordance with the Royal Pharmaceutical Society Guidelines. (Previous timescale of 31.01.05 not met.) The registered manager must ensure that MAR sheets are monitored on a regular basis. (Previous timscale of 31.01.05 not met.) Version 1.10 Timescale for action 31.01.05 2. 7 18(i)(2) 31.01.05 3. 7 18(i)(2) 31.01.05 and ongoing 31.01.05 and ongoing 4. 9 13(2) 5. 9 13(2) 23.05.05 and ongoing Rock House Page 24 6. 15 16(2)(i) 7. 19 10(1) 8. 21 23(2)(b) 9. 22 23(2)(n) 10. 24 16(2)(k) 11. 12. 24 38 23(2) 23(4)(d) 13. 38 13(4) 14. 38 Schedule 4(12)(a) 15. 38 23(2)(l) 16. 38 13(4) The registered manager must ensure that mealtimes are better managed to ensure that residents preferences and dietary needs are catered for. The registered manager must ensure that entries in the maintenance record book are clear and kept up to date. The registered manager must ensure that hot water taps in the following bathrooms and toilets are rectified: 118,119,218,007 The registered manager must ensure that a support frame is provided in toilet 008 and the call bell is accessible in toilet 007 The registered manager must elimnate the odour in bedroom 009 or replace the floor covering. The registered manager must risk assess the electrical adaptor in bedroom 222 The registered manager must ensure that night staff participate in two fire drills yearly. The registered manager must ensure that opened sauces stored in the refrigerator are labelled and dated. (Previous requirement of 31.01.05 not met) The registered manager must monitor the content in the accident book to ensure that entries recorded are clear and detailed. The registered manager must ensure that all COSHH cleaning solutions are kept in a locked cupboard. The registered manager must develop a generic risk assessment for the use of bed support rails. Version 1.10 23.05.05 and ongoing 23.05.05 and ongoing 23.05.05 30.08.05 23.5.05 23.5.05 and ongoing 30.08.05 and ongoing 23.05.05 and ongoing 23.05.05 and ongoing 23.05.05 and ongoing 30.08.05 Rock House Page 25 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. 2. 3. 4. 5. 6. Refer to Standard 9 10 15 16 20 38 Good Practice Recommendations It is recommended that the registered manager should develop protocols for Insulin administration and Fosamax medication. It is recommended that the registered manager should provide facilities for residents to make and receive telephone calls in private. It is recommended that the registered manager should review the practice of disposing of waste food in the dining room. It is recommended that the registered manager should keep a record of all verbal concerns and complaints. It is recommended that the registered manager should replace the cushion cover for the arm chair in the South Wing It is recommended that the registered manager should ensure that night staff participate in at least one table top evacuation. Rock House Version 1.10 Page 26 Commission for Social Care Inspection Cambridge House 8 Bell Business Park Smeaton Close Aylesbury, Bucks, HP19 9JR 01296 737550 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 Rock 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. 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