Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Skell Lodge South Crescent Ripon North Yorkshire HG4 1SN The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Martin
Date: 2 8 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home
Name of care home: Address: Skell Lodge South Crescent Ripon North Yorkshire HG4 1SN 01132382690 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Maria Mallaband Ltd Name of registered manager (if applicable) Mrs Lynda Vivienne Harland Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 23 The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. maximum number of places, 23 Date of last inspection Brief description of the care home Skell Lodge is a large, detached house situated in a quiet area within walking distance of Ripon city centre. The home is owned by the Maria Mallaband Group Ltd and is registered to provide residential care for up to twenty-three residents. The home provides accomodation on two floors, with a modern passenger lift to transport people between floors. There are currently nineteen single bedrooms and two double bedrooms. Sixteen bedrooms have en-suite bathroom facilities. There are small gardens and a small parking area. At the time of our visit fees ranged between 321 Care Homes for Older People
Page 4 of 33 care home 23 Over 65 23 0 Brief description of the care home and 399 pounds per week. Up to date information about fees, terms and conditions should be sought from the homes manager. Care Homes for Older People Page 5 of 33 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. The inspection took place on 28th January 2009, with a total of 8 hours being spent in the home. The site visit was completed by one inspector. During our visit we spent time observing care practice, talking to people who live at the home, talking to staff and discussed things with the homes registered manager. We observed a lunchtime meal and looked around the home. We also looked at a selection of the records that are kept by the home. Before our visit we sent a selection of surveys to people who live at the home, the staff and health care professionals who visit. Seven people who live at the home, seven staff Care Homes for Older People
Page 6 of 33 and three health care professionals completed and returned surveys to us. The comments and findings from these surveys have been included in this inspection report. Since this services last inspection we have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 33 Skell Lodge has continued to provide a good standard of care since the last inspection. The manager has been keeping up to date with legislative changes and providing up date training for staff. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 9 of 33 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to look round the home and have their needs thoroughly assessed before moving into Skell lodge. This helps to make sure that the home can meet their needs and is somewhere they want to live. Evidence: We looked at three peoples care records during our visit. These contained records of the homes assessments, which had been completed before people came to live at the home. The manager also showed us the new assessment paperwork that is now completed before people come to live at Skell Lodge. This provides an in depth assessment and helps the manager decide if Skell Lodge can meet peoples needs. The manager confirmed that if social services are involved in someones care information is gathered from them before admission. We saw records which supported this. The manager told us that people are invited to look round the home and can stay for a
Care Homes for Older People Page 12 of 33 Evidence: meal if they want to. Written information about the home is also available. This helps people decide if Skell Lodge is somewhere they would like to live. All seven people who returned surveys told us that they had received enough information about the home before moving in to help them decide if it was the right place for them. Care Homes for Older People Page 13 of 33 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the care and support they need from caring staff and from health care professionals when they need it. However, although people receive help with medication and appear to get the medication they need, the home needs to improve the way staff record in the Medication Administration Record and Controlled Drugs Register. Evidence: People we spoke to made the following comments about the staff and the care they received on the whole very good, polite and well mannered, I think they do very well, try to treat people well, I dont hear them being sharp with anyone, they seem very patient, if I need a doctor or nurse theres very quickly one brought in, the staff are very kind and very obliging and a very nice atmosphere. Five people who returned surveys told us that they always got the care and support they needed, while two people answered usually. During our visit we observed staff being kind and polite with people, talking and interacting in a cheerful and well meaning way. Care Homes for Older People Page 14 of 33 Evidence: We looked at three peoples care records. These contained the relevant assessments, risk assessments and care plans, provided a lot of information about peoples needs and were reviewed regularly. However, although changes in peoples needs were recorded in their review notes, the care plans themselves were not being updated. For example, according to one persons review notes they now need full staff assistance to maintain their personal hygiene, but their care plan still said that they were independent and just needed assistance with bathing. To get a full and up to date picture of peoples needs staff currently need to read through all of the review notes, because just reading the care plan would be misleading. Care records showed that people had contact with health professionals when they needed it. For example, records showed that people had recently seen their doctor, district nurse and chiropodist. Three health care professionals returned surveys to us and were generally very positive about the service provided. Comments included I feel they are very caring and treat patients as individuals. The residents are made to feel that this is their home and they always work together well with health care professionals and act on their recommendations. We spent time looking at how medication is administered and stored at Skell Lodge. The home uses a monitored dosage system which is provided by a local pharmacy. Medication is stored securely and staff have received relevant training. One person living at the home has chosen to self-medicate. Generally people appeared to be getting the help with medication that they needed. However, we found that some of the entries that staff were writing on the medication administration records (MAR) were not as accurate or carefully recorded as we would expect. For example, one medication had been discontinued, but this had not been recorded on the MAR by staff. A new medication had been added to the MAR by hand, but all of the required information had not been recorded. In addition the handwritten entry had not been signed by the person who made it and had not been checked and signed by a second person. We also found that there was some over-stocking of controlled drugs. For example, one person had four bottles of oramorph, three of which were opened and in use at the same time. Not all of the bottles had been dated when they had been opened, meaning that it was impossible to tell if they were still within the timescale for safe use. We found that the recording in the controlled drugs register for one persons temazepam did not match the stock balance that was actually available. There was one tablet less available than the controlled drugs register said there should be, because staff had not recorded the tablet that had been given on the previous Sunday night (the person concerned confirmed that staff had actually given them their medication). We also noticed that staff who are giving out medication are often interrupted, because people need help with other things. This is not good practice due to the increased risk of errors that interruptions create. These issues were raised with
Care Homes for Older People Page 15 of 33 Evidence: the manager during the inspection, who promised to look into them urgently and to speak with the staff members concerned. Care Homes for Older People Page 16 of 33 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a varied and appetising diet. Routines in the home are flexible and there are activities that people can take part in. However, activities could be developed further, to ensure that everyone has access to stimulation and activities which meet their individual needs and preferences. Evidence: Peoples comments about entertainment and social activities at Skell lodge included entertainment two or three times a month, communion, a service, a man who sings, havent got much entertainment, we could do with a bit more, its one of those things that doesnt come about, staff dont have a lot of spare time, but theres occasional entertainers and now and then there is something in the afternoon, someone sings, or we go and play games, dominoes, arrange flowers and various things. During the day of our visit we didnt observe any activities taking place. Some people sat in the lounge watching television, which during the afternoon was tuned to childrens programmes. Other people spent time in their rooms. Staff were generally busy doing their care tasks, although we saw that when staff did stop to speak to people they were attentive, polite and cheerful. Comments made in staff surveys included we could try to amuse/entertain the residents who stay in their rooms most of the time
Care Homes for Older People Page 17 of 33 Evidence: better and with extra staff we could provide better social activities. We spoke to the manager about activities. She told us that it is sometimes difficult because people dont want to join in with organised activities. However, she has ordered an entertainment pack, which includes activities for people with short term memory loss and hope that this will help staff provide more stimulation for people. Peoples comments about routines in the home included you dont have to do anything you dont think you can cope with, I do exactly as I want, Im a late going to bedder, others like to go early and theres no restrictions, just common sense used, they always say are you ready for bed or do you want to stay up a bit longer. The manager told us that she likes the home to be focused on the residents and what they want, because it is their home. People living at Skell lodge made the following comments about the meals if you want something particular you just have to ask and theyll get it for you, on the whole the food is quite good, always a choice of two things at main meals and you can always get an omelet or something if you dont want a particular thing and I think its very good, odd day may not be what you like, but its always served beautifully and I think they try to please you. We observed the lunch time meal and spoke to the cook, who knew peoples dietary needs well. The dining room was pleasant, with the tables set nicely. The meals were served by the care staff, with vegetables either served in tourines or already on the plates, depending on peoples abilities and preferences. The meal was battered fish or cold chicken with salad, both served with chips and pees. There was sponge pudding and cream for desert. The food was nicely presented and looked appetising. During the meal people made comments like oh this is nice, I dont know where to start, I had a teacake yesterday for tea and it was lovely and oh, its hot, lovely, but hot. We also saw that people were given hot drinks and biscuits between meals, several times during the day. Care Homes for Older People Page 18 of 33 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users feel able to raise any concerns that they have with the homes staff. Staff have been trained and know what to do if anyone has concerns about the home. This means that people are protected by the homes complaints procedures. Evidence: The home has a complaints procedure and information telling people how to complain was available in the homes reception area, next to the visitors book. People we spoke to felt that they would be able to let staff know if they had a problem. Comments made by people living in the home included oh yes definitely, shell (the manager) come as soon as she can and would sort out any problems, Ive not had any complaints, but could approach the manager if needs be, she would listen, definitely and if there is something you dont like you just say and they are most obliging. There have been no formal complaints made recently, either to the home or directly to CSCI. However, the home has introduced a niggles book where people can write small concerns and have them dealt with, without feeling that they have to make a formal complaint. We looked at this and saw that one person had not liked the new salt and pepper pots that had been purchased. The manager had dealt with this and had purchased replacement pots. Staff told us that they knew what to do if they or someone else had concerns about the home. They had also recently received training on safeguarding and how to protect people from abuse.
Care Homes for Older People Page 19 of 33 Care Homes for Older People Page 20 of 33 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Skell Lodge provides people with a safe, pleasant and homely place to live. Evidence: We looked around the home. Skell Lodge is a large old detached house situated in a quiet area of the small city of Ripon. Some people let us look in their rooms. We found that people had personalised their rooms with their own furniture, ornaments and pictures. This made them individual and homely for people. The communal areas of the home were decorated and furnished in a homely and comfortable style. For example, the chairs and settees in the lounge were of a domestic style. In a recent residents meeting people living at the home had decided that they liked this style of furniture and did not want it replacing with furniture of a more institutional type. The manager told us how the lounge and dining rooms were about to be redecorated and new curtains were being bought. People living in the home had been asked to help choose the new table cloths and napkins for the dining room. We checked a selection of the homes maintenance records. These showed that the homes gas and electrical systems, hoists and lift were all regularly serviced, helping to ensure that the people have a safe and well maintained place to live. The manager
Care Homes for Older People Page 21 of 33 Evidence: also told us how a new call system and fire alarm system were about to be installed, updating the homes current facilities. The majority of people who returned surveys told us that the home was always kept clean and fresh. The few remaining people said usually. Comments made by people who live at Skell Lodge included the home is usually fresh and clean, they keep the place clean and tidy, anything you want doing you just ask and my room is hoovered and done everyday. During our visit the home was clean and tidy and domestic staff were on duty. However, we did notice that a couple of rooms smelt unpleasantly. We discussed this with the manager, who told us that en-suite bathroom carpets are gradually being replaced with a more hygienic floor covering that can be cleaned more easily. This and any other action needed to prevent unpleasant smells in the home should be done as soon as possible. Care Homes for Older People Page 22 of 33 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited safely and provided with the training and support they need to do their jobs well. However, staffing levels and the way staff are deployed could be improved. Evidence: We spoke to the manager about staffing levels at Skell Lodge. She told us how there are usually two care staff and herself on duty during the week. At weekends there are three staff on duty on Saturday and two staff on duty on Sunday. During the night there are two staff on duty. This is for up to twenty-three people, although at the time of this inspection there were only nineteen people living in the home. The manager does not have any designated management time, having to fit in the management of the home around the care work. Comments made by people living in the home and staff included I think there are not enough really, they try the best they can but I think at busy times, before meals, getting up, they could do with an extra one, I think sometimes the staffing of the home should be looked into, maybe a few more is needed, like sometimes beds are not made until late afternoon, there is never enough staff on any shift, there is never enough time to do the paperwork expected, there is little time to actually spend a great deal of time with the individuals, other than what is necessary, theyre very willing, but it usually happens that someone else wants help at the same time and they cant be in two places at once and with more staff we
Care Homes for Older People Page 23 of 33 Evidence: could provide better care and more social activities. We looked at the recruitment records for two staff who had started working at the home in the last year. These showed that staff went through a thorough recruitment process. Before they started work a criminal records bureau (CRB) disclosure and two written references had been obtained. New staff were also put on a three month probationary period, with records showing that their performance was regularly reviewed during this time. Completed induction training checklists were in both staff members files and the manager showed us the induction workbook that all new staff complete. The manager told us that she thinks training is very important and beneficial. Nine of the homes fifteen care staff have completed a national vocational qualification (NVQ) in care. Another three staff are currently working towards this qualification. Training in manual handling, first aid, fire and food hygiene is provided regularly. Other training that is provided includes abuse and medication. The manager plans to provide formal training in dementia and the new Mental Capacity Act in the next few months. She also builds training into the regular staff meetings. We saw records of this and saw that she did a session on the Mental Capacity Act during a staff meeting on the day of our visit. Staff comments included frequent staff meetings are held and training sessions, this enables all staff to try to keep up to date, the manager holds meetings at least once a month and our care manager is always willing to discuss and give us support in our work, we also have regular supervisions. Care Homes for Older People Page 24 of 33 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed well and with the involvement of staff and people who live in the home. Systems are in place to make sure that things are done well and that people are happy with their care. The home is generally a safe place to live and work, although the manager needs to make sure that two specific health and safety issues are addressed. Evidence: The manager of Skell lodge is registered with CSCI and has recently completed the Registered Managers Award. This is a specialist qualification for people who manage care services. People we spoke to knew who the manager was, said they had regular contact with her and felt she was approachable. Staff who returned surveys and who were spoken to said that they felt supported and could raise any concerns they had. Comments included this is a very attractive and well run home, we have full support from the care manager and the manager holds meetings at least once a month. However, the manager does not currently have any designated management hours.
Care Homes for Older People Page 25 of 33 Evidence: She has to help the care staff who are on duty with the care of residents and fit in the management of the home where she can. It is to the managers credit that the home is being well managed despite this restriction. We looked at the systems that the home has in place to help people manage their personal monies. People who cannot or do not want to look after small amounts of personal money can ask the home to do this for them. The money and records are stored securely. We checked two peoples records and found that these were accurate, with each entry being signed by two people to make sure it is correct. Receipts for purchases, hairdressing and chiropody services were available. However, the records sheets were not always being fully completed, with the details column sometimes being left blank. This made it more difficult to see what peoples money had been spent on and to tell if money was being used appropriately. It is recommended that the sheets should always be fully completed. We talked to the manager about the homes quality assurance systems and looked at records. An area manager from the company that owns the home visits regularly. During their visits they talk to people who live at the home, audits medication systems and care records and generally check that the home is being run properly. Once a month someone from the companys human resources department visits the home to check the staff records. The manager told us they really are a good company...They dont mess about if things arent done properly. The manager holds regular meetings with staff and people who live at the home and their relatives. We saw records of these, which showed that people were consulted and kept informed about things in the home. The manager also regularly audits the medication systems and reviews things like health and safety risk assessments every three months. The companys head office send surveys to people who live in the home and staff approximately once a year and the results are then displayed in the home. We looked at the homes maintenance records and talked to the manager about health and safety. Maintenance records showed that the homes equipment was regularly serviced and kept in good working order. Health and safety risk assessments had been completed and the manager reviewed these every three months to make sure that any new risks were identified. We saw records confirming that regular checks are carried out on the homes fire alarm and fire equipment. This makes sure that the equipment is in safe working order. We also found that staff received regular fire training and training in other important areas, such as manual handling. However, at the fire officers last visit the home was told to make sure that appropriate door closures were fitted to bedroom doors. At our inspection visit this had not been fully actioned and some doors were still being propped open inappropriately. The manager assured us that a new fire alarm system (which includes a specialist door closure system) was
Care Homes for Older People Page 26 of 33 Evidence: about to be installed. This needs to be done as soon as possible to ensure that people are adequately protected if there is a fire. We also found that one person uses bed rails, but did not have the appropriate risk assessments and maintenance records in place in their care records. Bed-rails can be dangerous if they are not used appropriately and should only be used in accordance with current good practice guidance. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 33 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must 31/03/2009 ensure that all recording relating to the handling, storage and administration of medication is accurate and of good quality. This includes all recording on the Medication Administration Record and in the Controlled Drugs Register. The Medication Administration Records and Controlled Drugs Register are legal documents and should always be completed fully and accurately by staff, in accordance with current good practice guidance. If records are not accurate and of good quality the home can not evidence that people are getting the medication they need or provide a full audit trail. 2 27 18 A review of staffing levels and staff deployment should be undertaken, to ensure 31/03/2009 Care Homes for Older People Page 29 of 33 that staffing meets the needs of people living in the home. This should take account of the dependency of people living in the home, the layout of the building, the need for designated management hours and the different tasks that care staff need to carry out. Staff need time to carry out tasks(such as medication administration and management tasks) without being interrupted. Both staff and people living at the home felt that staff were sometimes too busy to provide the high quality of care and attention that they wanted too. Staff also need time to undertake and develop activities within the home. 3 38 13 Bed-rails should only be used in accordance with current good practice guidance. Individual risk assessments and maintenance records should always be in place. Bed-rails can be dangerous if used inappropriately. They should only be used in accordance with current good practice guidance from the Medical Devices Agency and the Health and Safety Executive. 31/03/2009 Care Homes for Older People Page 30 of 33 4 38 23 Action must be taken to meet the requirements of the Fire Officers last inspection report. People may be placed at unnecessary risk in the event of a fire if appropriate door closure systems are not put in place and doors are propped open inappropriately. 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 7 Where peoples needs have significantly changed their care plans should be updated to reflect the changes. This is important so that staff can easily access up to date information about peoples needs, rather than having to read through all of the review notes to get a full and up to date picture. Effective systems for the return and ordering of controlled drugs should be put in place, to ensure that the home does not accumulate medication and become over stocked. Where medication must be used or disposed of within a certain period after opening (for example, some liquid medications or eye drops), staff should always record the date of opening on the container and should ensure that it is not used after the timescale for safe use has ellapsed. Staff who are administering medication should not be interrupted during this task. Interruptions can cause an increased risk of medication errors and poor recording practices. Time and staffing for organising and carrying out activities, social events and one-to-one sessions should be included in the homes staffing arrangements. This would enable staff to provide more social stimulation to people living at the home and to tailor activities to peoples individual needs and preferences. En-suite carpets should be replaced with hygienic flooring 2 9 3 9 4 9 5 12 6 26 Care Homes for Older People Page 31 of 33 and any other action necessary to prevent unpleasant smells in the home should be undertaken as soon as possible. 7 31 The manager of the home should have designated management hours where she is not counted in the numbers of care staff or required to help with the care of residents. This is important so that she has the time needed to manage the home without impacting on care staffing hours. The financial transaction sheets which are used to record peoples individual personal financial transaction should always be fully completed. This will make it easier to see if peoples money is being used appropriately. 8 35 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
