Inspection on 26/06/06 for Sedlescombe Park Residential Home

This inspection was carried out on 26th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Sedlescombe Park Residential Home 22/05/08

Sedlescombe Park Residential Home 15/05/07

Sedlescombe Park Residential Home 28/12/05

Sedlescombe Park Residential Home 23/09/05

Sedlescombe Park Residential Home 26/08/04

Sedlescombe Park Residential Home 01/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Sedlescombe Park Residential Home 241 Dunchurch Road Rugby Warwickshire CV22 6HP Lead Inspector Sandra Wade (Lesley Beadsworth – Second Inspector) Key Unannounced Inspection 26 June 2006 08:15 X10015.doc Version 1.40 Page 1 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 Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 2 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. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sedlescombe Park Residential Home Address 241 Dunchurch Road Rugby Warwickshire CV22 6HP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01788 813066 01788 813066 Pinnacle Care Ltd Mr A Dytham Mrs Anna Josephine O Connor Care Home 24 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (2) of places Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered manager (Anna O`Connor) must obtain a suitable management qualification (equivalent to NVQ 4) by December 2006. 28th December 2005 Date of last inspection Brief Description of the Service: Sedlescombe Park is a large detached dwelling set in its own grounds, off the main Dunchurch Road in Rugby. The home is approximately ¾ mile from the town centre. There is a local bus route into the town along Dunchurch Road. A small range of local shops are near by. The Care Home is registered to accommodate up to 24 older persons with dementia. The accommodation is over two floors accessed via a passenger lift. Accommodation is mostly single rooms with some shared rooms. There are 2 lounges and a large conservatory has recently been built to the rear of the property, which serves as a dining room. The corridors throughout the home are narrow which makes it difficult for wheelchair users. The front entrance to the home is via two steps but there is alternative access for wheelchairs from the side and back of the home. There is no hearing loop in this home but the manager advised that at the time of this inspection, none of the residents were using hearing aids. Gardens to the front and rear of the property are landscaped. A drop off and turn area for cars with a small parking area is at the front of the property. The services provided for service users at Sedlescombe Park are on a personal care basis only for people with dementia. Nursing care is not provided in this home, nursing needs are met by the district nurse services. At the time of this inspection it was confirmed that fees for the home range from £400.00 to £480.00. Extra charges are made for chiropody -£10.00, hairdressing – approx £5.50, toiletries approx £8.00 per month and bus trips £9.00 per trip. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key inspection to Sedlescombe Park for this inspection year. The inspection process consisted of a review of policies and procedures, discussions with the manager, staff and residents. This inspection took place between 8.15am and 7.45pm and was undertaken by two inspectors. Records examined included care plan files for residents, recruitment records, staff files, training records, social activity records, staffing records and medication records. Records relating to the care and services provided by the home were also viewed. Before the inspection, service users and their relatives were sent questionnaires, to seek their independent views about the home. One comment card from a relative was received by the Commission but no visitors were seen during the inspection to obtain further comments and views on the home. It should also be noted that due to the dementia diagnosis of residents in this home, it was not possible to get detailed comments and views from residents on some matters. A pre-inspection questionnaire was received from the home on 20 April 2006, some of the information contained within this document has been used in assessing actions taken by the home to meet the care standards. On arrival to the home there were five residents sitting in the lounge some of them had a cup of tea and some toast. Staff were assisting residents to get up as well as provide support to those residents in the lounge. What the service does well: Staff observed during the inspection were friendly and supportive towards the residents. It was difficult to get full opinions from residents in regard to their care in the home but it was observed that residents reacted positively to staff and smiled when staff were talking to them. One resident was able to say they “could not fault the home” and liked the staff. Comments received from a relative of a resident in the home stated that they could not thank the staff enough and that their relative’s welfare always came first. They say that “kindness, happiness was felt and shown as soon as the doors were open to you” and “you are always made very welcome”. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Information that is made available to prospective residents needs to be updated. The manager needs to write to residents following their assessment to confirm the home can meet their needs. Care plans are in need of review to ensure they identify all residents needs, professional input, staff intervention required to meet their needs and evidence that needs are being met. Medication is in need of further review to ensure this is managed safely. This matter has been an ongoing concern for this home and must be addressed effectively. Privacy and dignity issues need to be addressed in regard to appropriate screening in double rooms and the return of residents personal clothing from the laundry. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 7 Residents and families need to be consulted in regard to the provision of activities in the home, which are suitable and appropriate to residents interests, hobbies and choices. One resident commented that they had an active mind and there wasn’t much going on in the home. Staff are to continue with their training on the identification and prevention of abuse to ensure all staff are fully aware of this and residents are safeguarded. There are matters regarding the environment, which require attention. This includes attention to some of the décor, availability of signage to assist and orientate residents around the home, the availability of suitable washing and drying facilities in communal toilets, suitable lighting and heating in all areas of the home and suitable storage facilities for chemicals, equipment etc. Residents were observed to be cold when the lounge door is left open and the front door to the home is in use. There is no level access to the front of the home for those residents with limited mobility (alternative access is available). An Immediate Requirement Notice was issued to the home to review all upstairs windows to check they had window restrictors and complete risk assessments to ensure resident safety. Staffing within the home is in need of review to ensure all residents needs can be met effectively. Staff training is being addressed gradually but it was not clear all staff are up-to-date with the required training. Some attention is required in regard to staff recruitment records to ensure these contain all of the required information prior to employment. It is evident there are numerous issues outstanding from the previous inspection which must be addressed. The management of the home must ensure sufficient time is allocated to addressing these issues so that the health, safety and wellbeing of the residents can be maintained. There was no evidence of quality questionnaires having been given to residents and families to obtain their views on the care and services provided by the home. The manager is to confirm that some health and safety checks have been carried out such as the gas safety check and the 5 electrical wiring check. Please contact the provider for advice of actions taken in response to this inspection. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 8 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 1, 3, 4 Quality in this outcome area is adequate. Residents are assessed prior to moving into the home to identify their needs but they do not get up-to-date details about the care and services provided by the home or receive written confirmation that the home can meet their needs. EVIDENCE: A Statement of Purpose and Service User Guide are available in the home and contain some information about the care and services provided. On viewing these documents it was found they were not up-to-date so that the relatives or representatives of residents could make informed choices about whether to accept a placement at the home. All residents are assessed prior to their admission to the home and records of these assessments are kept on file. It was not evident that copies of any assessments carried out by Social Services were available on files to assist staff when devising care plans to meet resident’s needs. The Admission Assessment Tool is made up of scores/boxes with pre-printed options for staff to complete. This format does now allow for differences to the Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 11 options listed to be indicated. For example the mobility section does not allow for any information to be recorded on walking aids, limps, awkward gait or the need to lean on something. The manager confirmed that letters are not being forwarded to residents following their assessment to confirm the home can meet their needs. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. Resident’s health, personal and social care needs care are not always being met and some residents are not treated with dignity and respect. EVIDENCE: Care plans had been devised for some needs but not others. A sample of residents were case tracked although some issues relating to other residents care were followed up as appropriate. Two inspectors reviewed care plans independently and found that all information in the care plans had to be read to get a full picture of the resident and their needs which was time consuming. This was due to the care plans not being structured in an effective way to enable a carer to pick up the care plan and immediately identify needs and the staff actions required to address these needs. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 13 From discussions with staff and reviewing care plans it was clear that carers do not rely on the information in the care plans because it is not always up-todate and correct. One resident was noted to have eaten some soap. A risk assessment had been devised following this incident, which stated any soap in the resident’s room was to be removed to prevent any reoccurrence. On viewing this resident’s room soap was found in their wardrobe and on the hand wash sink, it was therefore not evident that the actions documented had been carried out which could place the resident’s health at risk. Care plan information acknowledged that this resident had dementia but there was no specific care plan stating how this presents itself and how it should be managed. One care plan profile viewed contained a life history and personal profile of the resident to assist staff when making decisions on how their care should be given as well as health care services they may need to be accessed. Interests and hobbies were listed such as crocheting but it was not clear whether the resident was still able to pursue these or that staff had attempted to provide the resident with the appropriate facilities to be able to do so. There were instructions in the “important each day” section of the care profile that said the residents dentures were to be cleaned. It was not clear from records that this was being done on a daily basis. During the tour of the home toothbrushes could not be found in some rooms. In one room there was no toothbrush and the residents dentures were on the floor. There was no care plan detailing the personal care to be given to this resident or how the resident should be supported to address personal care. An entry in the care records said the resident liked a bath on a regular basis but it was not clear how often this was to be given. There were no care records viewed to confirm a toileting programme is in place and staff were unsure that there is a toileting programme available to maximise residents independence in regards to the management of their continence. A residents likes and dislikes in regard to food had been listed. The resident was observed to be frail and thin. The weight chart in their care profile stated that they were 8 stone on admission. September had been listed as the next time the resident was weighed but the full date had not been completed. In September, which appeared to be two months from the admission date, the resident weighed 7 stone 2lb. The next weight recorded was November when the resident weighed 7 stone. The resident continued to lose weight up to January 2006 when they weighed 6 stone 7lb. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 14 In February records state the resident was in hospital. It is not evident that staff were taking any actions in regard to the fact this resident was consistently losing weight. It was established that the home do have a set of sit-on scales but these are on loan to another home. Staff were not clear what weighing scales were available in the home, if any, to ensure residents could be weighed. A nutritional assessment completed by staff had not been kept up to date so that any risks of malnutrition and poor health could be fully identified. On observation of the resident concerned in the morning, it was noted that half a slice of toast was on a plate in front of them and the other half was in their tea. A member of staff came along and asked if they had finished with it and took it away. It was observed that several of the residents in this home looked frail and thin although good choices of meals are available. The manager said that there were five residents who were being assisted to eat and one of these had swallowing difficulties. Details of meals that residents had eaten were not being maintained in the home sufficiently to identify if residents were eating a nutritional and wholesome diet. Detailed food and fluid intake charts are not being completed for those residents who have lost weight so that this can be monitored to ensure their health can be maintained. A resident who fell in the home and sustained a fracture did not have any care plan in place stating how the residents care was be managed around this to ensure their personal care, eating, sleeping etc could be managed effectively. It was also not clear what further medical interventions would be required in regard to the fracture. It was not clear from the professional visits sheet in the care profile that the doctor was called following the fall. A statement had been written on this sheet to refer to the daily records where the doctor’s visit was indicated. The professional visits sheet should also contain clear details of the doctor’s visit and the outcome of these visits so that when the daily records are archived there is a clear medical history still available. One care plan profile showed several care needs on one page making it difficult to make any changes to these without re-writing the whole page. This was dated August 2004 and had not been reviewed again until 27.7.05. Care plans detailing the care needs of residents should be reviewed monthly to check there are no changes required to their care regime or amount of support they need from staff. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 15 The nutritional assessment for this resident had been done in July 2005 but had not been updated to ensure their nutritional needs had not changed. A risk assessment form had been completed identifying this resident was at risk of weight loss and falls. Other risks were also listed. It was not evident that the risk of weight loss had been identified anywhere else in the care plan profile so that staff were clear on what actions needed to be taken to address this. The only instruction to staff was to weigh the resident weekly and records available showed that this was not being done consistently. Instructions were changed for this resident to be weighed monthly then 3 monthly – both charts showed this was not being done within these timescales. A professional visits sheet in the care plan profile showed that the GP had visited and the treatment carried out but records did not state why the visit was necessary. Daily records had been completed and times of the entries had been recorded but these did not show that the care needs as described in the care profiles were being met. The bath and shower chart for this resident was last completed in August 2005 and it was therefore not clear this resident’s personal hygiene is being maintained effectively on an ongoing basis. In one care plan profile the “important each day” section detailed some day to day needs that conflicted with the information in the assessment information. For example a resident is indicated in one document to be incontinent of faeces day and night but in the other document it says they “occasionally has faecal incontinence otherwise no problems”. It is clear that this had occurred because records had not been updated. Chiropody visits had been documented in one care plan file viewed but it was not clear that this was being provided on a regular basis. District nurse visits had been recorded to show specialist support being given. A review of medications was undertaken and it was identified that actions are still required to ensure this is being managed effectively and safely. There were gaps on some of the medication records viewed so it was not clear whether the resident had been given their medication. Records of incoming medications had not been completed consistently so it was not possible to check that medications received and given were correct in accordance with the records available. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 16 • Lorazepam medication prescribed for one resident had not been given for 3 weeks because the home had ran out of it. It was not evident that any actions had been taken by staff administering medications to follow this up. A member of staff stated that the resident had come from another home with a limited amount of medication and due to changing GPs the medication had not been provided yet. Allowing prescribed medication to run out of stock results in the omission of care and could have an adverse effect on the health and well being of resident’s. One resident had run out of eye drops and on the medication record it stated, “none supplied this cycle,” suggesting none were ordered. “G” had been written on the medication record, which had been defined as “no stock available”. Minimum and maximum fridge temperatures had not been recorded – only the ‘current’ temperatures are recorded. Some of the initials made on MAR Charts were not legible. Staff were using the code “F” on the medication records but this was not always defined so that it was clear what this meant. A packet of loose paracetamol was found in the medication cupboard. All medications should be kept in their named prescribing boxes to prevent errors. It was not evident that boxed medications which were left over from the previous month had been documented and carried forward onto the next medication record to that staff would be clear at the beginning of each prescribing period how many tablets/capsules they have and there is a clear audit trail. Some of the medications were not stored in a cupboard in the medications room to ensure they were fully secure. One resident’s medication was in a named Tupperware container with a different resident’s name on it, which could cause confusion to staff administering the medications. Handwritten entries on the medication records had not been dated and signed so that it was clear when the changes had been made and by whom. The breakfast medication round on the day of inspection was noted to still be ongoing at 11am which could mean that those residents who are due a lunchtime medication would not have a sufficient gap in between doses. This could impact on the resident’s health. DS0000004295.V287947.R01.S.doc Version 5.2 Page 17 • • • • • • • • • • Sedlescombe Park Residential Home The current medication procedure for the home was viewed which had been produced by Head Office. This stated that no trolley of any description is to be used which results in staff having to go back to the medication room for each persons medication one at a time. As the blister packs in the medication room are not locked in a cupboard this means that the door would need to be locked and unlocked each time the blister pack is removed and returned to ensure medications are kept securely. The manager explained that the Registered Provider was keen to maintain a homely atmosphere and this is why the policy states staff are not to use a trolley. It is however evident that the current system needs to be reviewed to ensure all residents receive their medication within a suitable and safe time frame. Staff confirmed that they had received some training on medications from the pharmacist and one member of staff said they were in the process of completing a distance learning training course, which was more detailed to help them undertake medication management more effectively. The manager had taken some actions to address issues raised at the last inspection including the provision of a new medications cabinet with lockable doors. Residents were seen to use all areas of the home and staff respected the privacy of those residents who wished to stay in their rooms. It was noted that double bedrooms do not have sufficient screens to ensure there is full privacy for each resident when changing, washing or using a commode. On arrival to the home it was observed that a bedroom door was fully open to one of the double rooms and both residents were in bed. Named underwear and clothing was found in resident’s rooms, which did not belong to them, which could result in residents wearing other people’s clothes. One resident said that she had lots of cardigans but they had all disappeared and she only had the one she was wearing to choose from. Care profiles confirmed some information in regard to resident choices in how their care is delivered. Some of the residents were observed to have keys to rooms or cabinets in their rooms demonstrating the choice to hold their own key had been given. However it was not evident that any risks for residents to hold keys were being appropriately managed. One resident had locked themselves out of their room and it was established has done this on several occasions. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 18 The manager advised that spare keys had been provided each time this person had lost one. One room with a Yale lock appeared to have been forced open at some stage. Staff were seen to offer choices of cereal or toast at breakfast time. One resident was offered a choice of cereal but said they would prefer toast, which was provided. It was not clear that cooked breakfasts are being offered. It was advised that menus are reviewed to show all food and drinks being provided in the home. A member of staff said that at lunch time they would usually show a resident both choices of meals so they could visually choose what they liked. Four-week rotation menus are in place and these show that a starter and two choices of main meal and a desert are provided. On the day of inspection the cook explained that he was not working from the menu as the freezer was over full and he was using up the contents. The meal served was liver casserole or corned beef fritters with mashed potato, cauliflower, peas, new potatoes and croquet potatoes. The cook confirmed there were five residents who required a soft diet and said they were being provided with the same foods but liquidised. Each food item was being liquidised separately. The changes in the menu had not been reflected in the records so that it was clear what food residents had eaten. The completion of these records enables the home to demonstrate meals residents have had to maintain nutrition and health. Records can also be referred to in cases of resident ill health to establish if there could be any foods responsible for this. One resident said that the food was “alright” and they had “no complaints”. One resident was being assisted to eat their ‘breakfast’ by a member of staff at around 11am in the corridor area as other residents had finished eating in the dining area. The member of staff ensured that the resident was not rushed to eat their breakfast and gave the support and encouragement required. The kitchen was viewed and it was observed there were fresh vegetables and fruit available. All foods in the fridge were appropriately wrapped and dated and the fridge and freezers were operating within appropriate temperatures to ensure food is being stored safely. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 19 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 the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. Residents have access to some activities and social outings but these are limited and do not fully satisfy their social and recreational interests. Residents are able to maintain contact with families and have some choice in how their care is given and enjoy the food being provided. EVIDENCE: Residents looked well presented and were seen during the day to mostly occupy the large lounge and dining areas. Some residents were seen to doze periodically during the day and others were active and freely wandered around the home. One resident was keen to go out shopping with a member of their family and was waiting in the entrance hall. Service users were observed to enjoy having one of the resident’s pet dogs around who kept sitting on their chairs. There were times during the day when residents were quiet and there was no interaction between them to periods when they were active and were chatting to staff. The manager said that musical activities and reminiscence took place once a month and on Thursday mornings there was usually a bus trip somewhere. The manager advised that activities, which residents participated in, were Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 20 recorded in an Activity Book in the lounge. This was viewed and listed activities such as bingo, bus trips to Draycote Water, Magpie Hill, watching videos, dominoes and birthday parties. Initials had been indicated next to activities to show which residents had participated. An activity schedule was requested during the inspection but was not provided to confirm the range of activities that take place on a monthly basis as well as the choices being offered to residents. The manager said that there is an activity co-ordinator who assists in providing activities for 7 hours per week and the rest of the time the reliance in on carers to provide these in addition to their caring duties. It was not evident that service user interests and hobbies as detailed in their care plan profiles had been followed up in a suitable activity programme demonstrating that residents are being consulted in regard to activities provided. A box of soft toys was available in the lounge area but none of the residents were seen to use these on the day of inspection. Some residents were playing bingo in the conservatory. A member of staff also put some music on for the residents in the lounge which some seemed to enjoy except one resident who got up and changed the music. It was not clear if this was their intention or whether they were trying to turn in down or off. During the inspection residents were observed to be given the choice whether they ate in the lounge area or conservatory. One resident who had been assisted to get up and dressed was asked by a member of staff if they wished to sit in the lounge or dining room. A carer gave a choice of sugar puffs or cornflakes at breakfast and a resident replied that they wanted toast, which was provided. One resident said that they had a very active mind but did not feel that staff appreciated this, as there was usually not much going on in the home. Care plans demonstrated that some choices are being considered such as times residents wish to get up and go to bed. One daily record stated that a resident chose to “have a lie in” suggesting residents are being given the choice when they wish to get up. Food likes and dislikes had been recorded on one file viewed but it was not possible to confirm that the resident’s choices in regard to food were being met. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 21 The visitors log kept in the manager’s office confirmed that residents receive visitors and previous inspections to the home have confirmed that visitors are made welcome to the home. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 22 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 the following standard(s): 16,18 Quality in the outcome area is adequate. Systems are in place to handle complaints and manage abuse but not all staff have completed training to ensure staff can identify and safeguard the residents from abuse. EVIDENCE: A complaints procedure is in place and this is on display in the entrance hall. This did not list full names, addresses and contact numbers of the management of the home and is written in a way that suggests the complainant contact the Commission before the manager or registered provider of the home. If a person were to ask for a copy of the complaints procedure to take it away to write a letter they would not have all the information on the current procedure they would need to do this. The manager confirmed they had received no complaints since the last inspection and records viewed confirmed the last complaint received was in 2003. As the majority of residents in this home have dementia they are reliant on staff to identify anything that may be concerning them and to manage this appropriately. The manager advised that approximately half of the care staff have attended training on the identification and management of abuse. Staff spoken to had not attended training but confirmed that if they observed abuse they would report it to the manager. It was not clear from discussions with staff what they would do about any resident who had suffered abuse and it was noted that the homes policy in regard to this matter was not fully clear. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 23 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 the following standard(s): 19, 21, 24, 25, 26 Quality in this outcome area is poor. The home is in need of improvements to ensure a sufficient, comfortable and suitable environment is available to residents where their safety can be maintained. EVIDENCE: A tour of the home was undertaken and it was evident that minimal work has been done since the last inspection to address concerns raised. Sign posting for the home remains poor and is not visible from the road making it difficult for visitors and prospective residents to find the home. During the inspection various doors within the home had been left open making it draughty and cold for the residents. The inspector was speaking to one resident who indicated they were cold and the manager collected a cardigan for them. Bedrooms continue to be varied in the level of decoration some were homely and furnished with resident’s own possessions and others sparsely decorated. There were unpleasant smells in some bedrooms. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 24 Two bedrooms have a dividing door between them, this was not locked, in one of these residents rooms there was a table blocking the adjoining door. It was noted that this door was indicated as a fire exit. The manager was advised to seek advice from the fire officer regarding this. One room had been nicely decorated and personalised but the lighting in this room was poor. In one room on the top floor there was no window restrictor on the window to ensure resident safety. An immediate requirement notice was issued to the manager to check that all upstairs windows had a restrictor. The décor was found to be of a basic standard, in one area the wallpaper had been painted over and there were creases in the paper visible. The wallpaper border in the corridor was torn and an aerial wire was hanging loose on the stairway. There were no curtains in this area. In the shared rooms seen the screening was not sufficient to provide total privacy when residents are washing and dressing which compromises the privacy and dignity of the residents. There was also insufficient furniture available for 2 people. In one bedroom the handles were broken on the chest of drawers and wardrobe. The window frames on the top floor of the home were damaged, flaking and the windowsills rotting. This was found to be the case at the previous inspection. Some signage was noted on toilet doors but otherwise there is minimal signage in the home to assist the residents to find their rooms. During the inspection one resident was noted to wander around one of the floors for some time trying to find their room. A member of staff eventually assisted this resident. Access to the gardens is via a ramp at the back door of the home or the ramp from the conservatory. Access to the front of the building is via two steps and any disabled visitors or wheelchair uses may therefore need to use the side door which can be accessed when the gate is unlocked. A general risk assessment had been carried out to assess the safety of residents when accessing the front entrance of the home. The assessment did not contain sufficient information to support the prevention of safety risks to residents accommodated in the home. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 25 There are no suitable facilities for staff to change and leave their outside clothing or to have an appropriate break away from residents. Staff therefore have to use resident areas, which is not appropriate. Storage in the home is a general problem. One of the store cupboards would not close due to the contents inside it. A hoist was being stored in a shared bedroom next to a bed of a resident who does not use the hoist. The small lounge was full of boxes of incontinence pads all day so there was no pleasant quiet area for residents to sit unless they sat amongst the boxes. Care staff advised that they would have to put these away into each resident’s individual rooms and although they managed to put some of these away, there were still some left at the end of the day. There are three bathrooms in the home and two of these have assisted facilities for those residents with limited mobility. The bathroom on the top floor of the home does not have an assisted bath and is not suitable for use by residents in the home. The Inspector was advised at the last inspection that the bath is not used which means residents on this floor would need to use an alternative bathroom. The unsuitability of this bath does decrease the number of bathing facilities available to residents. The bath was noted to be stained around the plug hole area. The toilet in this room was also stained. Another toilet had an unpleasant odour and the wash-hand basin was stained. No drying facilities were available for staff or residents to dry their hands. In one of the toilets the light bulb had gone and was not replaced all day, it is important this is done promptly so that residents are not placed at risk of falls. One of the bathrooms, which did have a bath chair to assist residents, had a marked floor with holes in it, which had been caused by the removal of a hoist. The kitchen was found to be cluttered and untidy both during and after cooking. The home has limited storage facilities which impacts on this. A fly zapper was seen in the kitchen but this had not been plugged in and there were no other deterrents available such as fly screens. It was observed that the home continue to use bars of soap and hand towels in bathrooms and toilets. This is poor infection control practice as there could be a risk of cross infection. In the assisted bathroom the towels were on the floor and the toilet roll holder was broken. Alcohol gel had been provided for staff to use as part of infection control within the home but storing it in a cabinet may compromise this. The use of this gel does not always replace the need for staff to wash and dry their hands. In one bedroom there was a folded pressure mattress in the corner with brown marks on it, the commode seat had faeces on it. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 26 The laundry is also being used as a sluice area and it is too small to maintain a dirty to clean flow of laundry so that good infection control practices can be followed. There is one industrial washing machine and two driers to manage the laundry of the home. The soap dispenser on the washing machine was in need of cleaning and there was a general look of uncleanliness in this room. The laundry/sluice room was cluttered, pipes and plasterwork is exposed, the walls were in need of painting, the windowsill was dirty and a yellow clinical waste bag was being stored in here. The door was wedged open throughout the day. Washing power and chemical cleaners and softener were being stored in here on a shelf and on the floor. Chemicals must be kept in a locked facility to prevent any health and safety risks to residents. Staff confirmed that the sink in the laundry is used to clean and soak commode pots. At the time the laundry was viewed this sink was also being used to soak soiled items of residents clothing. There was no dedicated hand-wash sink for staff to wash their hands and liquid soap and paper towels were located at the sluice sink suggesting this is where staff are washing their hands. It is not clear how staff can wash their hands when the sink is being used for other purposes. Red and grey baskets were in the laundry and the manager confirmed these are both used for dirty washing. Baskets were not labelled to ensure all staff are using them for this purpose. Due to insufficient space the baskets for clean laundry were being kept in a cupboard. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 27 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this area is poor. Staffing is operating at minimum levels and is not based on the identified care needs of residents, which could lead to an omission in resident care. Recruitment policies and procedures are in place to ensure the support and protection of the residents but these are not being consistently followed. EVIDENCE: On the day of inspection there were 23 residents in the home, 22 of which had a diagnosis of dementia with a range of care needs. It was established that there are periods during the day when there are insufficient staff available to meet the care needs of the residents. The Department of Health Residential Staffing Forum Guidelines recommend that the home have four care staff on duty during the day time solely for providing care. The manager confirmed that they aim to provide four care staff on duty each day and two waking night staff. The usual shifts for care staff are from 8am to 2.30pm, 2.30 – 5.50pm and 5.30 – 9.30pm but there are also some staff who are working split shifts from 7.30am to 11am and then 5.30 - 9.30pm. It was noted from discussions with staff and viewing duty rotas that there is some inconsistency in staff availability at certain times of the day. This in particular applies to when staff are working split shifts, which can mean there are less than 4 care staff available. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 28 It was established that sometimes the manager works on the floor between 11am and 2pm to ensure there are enough staff to care for the residents. The manager is required to work in a supernumerary capacity so that management duties for the home can be completed effectively and therefore the managers hours should not be counted in with the care staff numbers. Duty rotas viewed for the home over a two week period in June showed that there is no staff handover period built into the shift times and the home therefore rely on the good will of staff to stay over their shift time to report to the new shift coming on duty on the health and welfare of residents. It was identified from discussions with staff that there are periods of time when they are busy and their time with the residents can be limited. Staff confirmed that they tended to work through their shifts without a break. A domestic is available for five days per week from 9am to 3pm, although these hours have increased from the last inspection, there are still two days a week when domestic duties are being covered by care staff, which takes them away from caring duties. Care staff are also required to do all the laundry in the home and make or finish tea for the residents and ensure that the kitchen is left tidy. The manager advised that a cook is available in the home each day from 7.30am to 2.30pm or 8am to 2pm. One resident said they were “looked after pretty well” and a comment card received from a relative stated that they felt there were sufficient numbers of staff on duty. There was only one comment card received by the Commission. Other residents approached to discuss staffing did not give responses to be able to establish their views on this matter due to their dementia diagnosis. The staff training schedule in the home was not up-to-date to get a full picture of all staff training completed. Staff training that had been organised over the last 12 months included food hygiene, fire, health and safety, dementia care, first aid, infection control and medications. There are still only two staff in the home who have attained a National Vocational Qualification (NVQ) II in Care. The manager advised that a further two staff were in the process of completing this and four staff were due to commence this training in September 2006. This should bring the home up to the 50 ratio as stated in the care standard to allow for staff to be suitably trained and provide effective care to the residents. Two staff files were reviewed to confirm recruitment practices in place. Both members of staff had completed application forms with a history of past employment and both contained criminal record checks. One member of staff did not have two references on file as required. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 29 Induction records were not available on either file to confirm staff had completed an induction to the home. The manager advised that the induction training booklets were with each member of staff as they were still working through the induction modules. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 30 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38 Quality in this outcome area is poor. Management systems in the home are not fully effective to ensure the health safety and welfare of residents can be maintained. EVIDENCE: The manager advised that she has been in post for 14 months as manager of the home and she has completed dementia care training and has attained a Diploma in Welfare studies qualification. The manager is also in the process of completing the Registered Managers Award qualification to comply with the Condition of Registration imposed at the time of her registration with the Commission. The manager advised that a questionnaire is forwarded to residents on a 12 monthly basis seeking their views about the home. The results of these questionnaires are then forwarded directly to the provider. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 31 The manager said that the last questionnaire was done in September/October 2005. Details of these questionnaires and the outcomes were not available to confirm this process had been carried out. The manager must be able to demonstrate that there is a regular review of the quality of care and services being provided and the results of any quality exercise are published in the home with details of actions taken to address any concerns raised. The inspection process confirmed that there are a number of issues where limited action has been taken from the December 2005 inspection. Some of these are linked to the homes management and operation, which need to be improved to ensure the safety of residents at all times. The home keep a visitor’s log in the managers office and does not detail arrival and departure times. This is important in case there are any incidents in the home such as a fire to ensure both residents, staff and visitors can be accounted for and are not placed at risk from harm. The home does not hold any money for residents as they are supported in managing their finances by relatives or a representative of their choosing. Since the last inspection a more suitable location for the storage of any monies in the home has been arranged and the manager advised that there is limited access to this storage area. The manager advised that supervision had commenced but this had not yet been achieved six times a year for each member of staff. This is important so that issues relating to staff performance can be discussed and any training needs can be identified and arranged as appropriate. Various chemical products were found stored in unlocked locations around the home such as under the stairs, in a cupboard by the kitchen, in a store cupboard on the first floor and outside a locked store cupboard on the second floor. All chemicals should be stored in locked locations to prevent any health and safety risks to residents. Two of the wheelchairs in the home were seen without footplates. Transporting residents in wheelchairs without these can put their safety at risk. Health and Safety records were viewed to confirm checks carried out. The Preinspection questionnaire forwarded by the manager showed that fire drills and fire training had been carried out in January and March 2006. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 32 The lift had been checked on 30 March 2006 and the call bells in June 2006. The hoists had been checked on 25.4.06. The five year electrical wiring certificate was not available in the home to confirm this check had been carried out. The Landlords Gas Safety Certificate could not be located to confirm all gas appliances in the home had been checked and were safe. Portable Electrical appliance testing records were not available to confirm these had been checked and were safe to use. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 33 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 2 X X 2 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 2 2 Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? Yes 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. 2. Standard OP1 OP4 Regulation 4,5 4 (1) (d) Requirement Timescale for action 31/10/06 3. OP7 12,15 The manager is to update the Statement of Purpose and Service User Guide for the home. The manager must ensure that 31/08/06 letters are written to residents following their assessment to confirm the home can meet their needs. 31/08/06 More information must be included in care plans with regard to resident’s health and medical needs and interventions. Written information must allow for methodical monitoring and provide evidence that all health care needs are identified, professional and specialist services are accessed and health care needs are continuously reviewed. Outstanding from inspection dated September 2005. Specific care plans must be in place for dementia care needs, which show how these needs are being addressed and monitored. The management must ensure DS0000004295.V287947.R01.S.doc 4. OP7 15 S3 31/08/06 Page 35 Sedlescombe Park Residential Home Version 5.2 that the care planned reflects the actual needs of the residents and when changes occur these are clearly indicated and new plans developed. Care plans must be evaluated monthly to identify any changes in support required. Outstanding from December 05 inspection. The registered manager must ensure that care prescribed is carried out which includes the monitoring of weight. This must be done accurately. The manager must ensure appropriate action is pursued for those residents who have lost weight to ensure this does not impact on their health. Above outstanding from December 2005 inspection. Sufficient records must be maintained of food intake of residents to be able to identify if their diet is satisfactory. The managers must ensure that risk assessments show an appropriate plan of prevention and ensure the actions identified are actually carried out. Risk Assessments must be reviewed monthly and changes in risk factors clearly recorded. Above issue outstanding from December 2005 inspection. Weighing equipment must be available to allow actions identified in care plans to be carried out. 7. OP9 13(2) All medicines must be available DS0000004295.V287947.R01.S.doc 5. OP8 12,13, S4(13) 31/08/06 6. OP8 17,15,14, S3,4 31/08/06 31/08/06 Page 36 Sedlescombe Park Residential Home Version 5.2 and administered at the right time and all records must reflect the exact transaction. (Above outstanding from December 05 inspection). Medication management is to be reviewed in accordance with details in the body of this report. The manager must be able to demonstrate that staff are competent to manage medications. 8. OP9 13(2)18(1 )19(1) 31/08/06 9. OP10 12 (3)(4) 10. OP10 12(4) (Outstanding from December 2005 inspection) The home must be conducted in 30/09/06 a manner, which maintains the dignity of residents. The manager is to undertake an audit of all residents clothing to ensure they all have their own personal belongings in their own rooms and have access to these. The registered manager must 31/10/06 ensure that the care home is conducted in a manner, which respects the privacy and dignity of residents at all times. Issues relating to the dividing door and screening in double rooms as detailed in the body of the report are to be reviewed. Above issues outstanding from December 05 inspection. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 37 11. OP12 4, 16, Sch1 12. OP18 13 (6) 13. OP19 13, 23 The manager is to further develop activities in the home to ensure that there are sufficient activities during the day that meet the interests, hobbies and abilities of the residents. The manager is to confirm when all staff have completed training in the identification and management of abuse. The registered manager must complete a detailed risk assessment, which demonstrates how the risk to residents is to be managed in regard to accessing the front entrance to the home safely. Outstanding from previous inspection dated September 2005 Plans for re-decoration and refurbishment of the home must take into account the mental health needs of residents admitted to the home. (Outstanding from December 05 inspection) The manager is to provide an Improvement Plan with dates, which addresses décor issues as described in the body of this report. 31/10/06 31/10/06 31/10/06 14. OP19 23 31/10/06 Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 38 15 OP19 23(2) 13(4) The manager must ensure that window restrictors are regularly checked. (This has subsequently been addressed) 28/06/06 16. OP21 23(2) The Registered Provider is to ensure there are suitable storage facilities for the purpose of the home. This includes both equipment and for items delivered to the home. The registered provider must 31/10/06 ensure that there are sufficient bathing facilities available to residents. (Outstanding from December 05 inspection) The registered manager must ensure residents’ provided with keys are suitably assessed, before a key is issued. (Outstanding from December 05 inspection) The registered manager must ensure that the temperature in the home is comfortable and appropriately heated to meet the needs of residents. The layout of the laundry needs to be reviewed to ensure that it is accessible and safe for use by all staff. Outstanding from previous inspection dated September 2005. 17. OP24 12(4)(a), 13(4) 31/10/06 18. OP25 23 31/10/06 19. OP26 23 31/10/06 Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 39 20. OP26 13(3)(4), 16 The registered manager must ensure that effective measures are in place to control the risk of infection. This includes suitable facilities where staff can wash and dry their hands. The home must be kept free of offensive odours. Above outstanding from previous inspection dated September 2005 The manager must ensure that insect deterrents in the kitchen are used consistently as appropriate. The manager must ensure that residents receive their clothes back from the laundry in good time. Staffing levels must be reviewed to ensure that there is sufficient staff on duty consistently to meet the needs of all residents accommodated in the home. Outstanding from previous inspection dated September 2005 Duty rotas must demonstrate care staff hours allocated to noncaring duties such as cleaning, laundry and catering so that the number of hours being provided for both care and domestic services can be confirmed as sufficient. 31/10/06 21. OP27 18(1)(a) 31/08/06 22. OP28 18(1) The registered provider must ensure that a minimum of 50 of care staff are suitably qualified to NVQ II level in Care. 31/10/06 Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 40 23. OP29 7,9,19 S2 24. OP30 18 The manager must ensure that 30/09/06 all recruitment information as required is collated prior to staff employment. The registered manager must 31/08/06 maintain an up-to-date training schedule which shows all training completed by staff to demonstrate staff are suitably, qualified to work with residents safely. Outstanding from September 2005 inspection. The manager must be able to demonstrate the management systems in place to ensure the suitable running and management of the home. Evidence must be available to demonstrate the effectiveness of these systems. 25. OP31 10 31/10/06 26. OP33 24, 26 27. OP36 18 (2) Outstanding from December 05 inspection. The registered provider and 31/10/06 manager must ensure that quality assurance and monitoring systems are in place and information is shared with the residents and their representatives. The registered provider must 31/10/06 ensure that all care staff are formally supervised six times a year, clear and informative records must be maintained and available for inspection. Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 41 28. OP38 23 (3) Suitable accommodation must be 31/10/06 available for staff to change their clothes and store personal items. Outstanding from previous inspection dated September 2005 Sufficient lighting must be available at all times throughout the home. The central heating system in the home must be serviced regularly and records maintained. (Above outstanding from December 05 inspection) Chemical products must be kept in secure locations. The manager must ensure that all safety testing of equipment is carried out as required and certificates maintained. This includes a copy of the Landlords Gas Safety Certificate. 29. OP38 23 31/08/06 Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 42 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 OP9 Good Practice Recommendations The medication refrigerator temperatures (maximum, minimum and current) should be recorded daily and all must lie between 2°C and 8°C to ensure the medicines requiring refrigeration are stored in compliance with their product licences to guarantee their stability. Outstanding from December 05 inspection. 2. OP13 It is advised that the manager improve the current system for monitoring visitors arriving and departing from the home for reasons of health and safety. The manager is advised to ensure all meals and drinks provided in the home are confirmed in the menu for the home to demonstrate these are being provided. This should include breakfast and snack meals provided in the evening. The complaints procedure should be reviewed to ensure this contains all contact telephone numbers and addresses and explains the procedures that should be followed prior to making contact with the Commission. The registered manager should produce a programme of routine maintenance and evidence of renewal of the fabric and decoration of the premises. The registered manager should provide suitable signposting, which identifies the location of the home. 3. OP15 4. OP16 5. OP19 6. OP19 Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 43 Commission for Social Care Inspection Coventry Area Office 5th Floor Coventry Point Market Way Coventry West Midlands CV1 1EB 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 Sedlescombe Park Residential Home DS0000004295.V287947.R01.S.doc Version 5.2 Page 44 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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