CARE HOMES FOR OLDER PEOPLE
St Clair House Care Home 32 Basset Road Camborne Camborne Cornwall TR14 8SL Lead Inspector
Paul Freeman Unannounced 15 August 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service St Clair House Care Home Address 32 Basset Road Camborne Cornwall TR14 8SL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01209 713273 01209 610699 Mr David William Maund & Mrs Beverley Maund Mr David William Maund Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection Brief Description of the Service: St Clair is a two storey georgian building has been extended at the rear and is situated close to the town of Camborne where a range of amenities and facilites are avaliable. The home is owned and operationally run by the registered providers Mr and Mrs Maund. The home generally has satisfactory access for people who experince disabilites with bedrooms situated on both floors and a passenger lift is also provided. The access at the front could be improved for individuals who are reliant upon a wheelchair. The ground floor provides two communial siting rooms at the front and rear and an attractive dinning room. The enviroment is maintined to a high standard and very attractive and well maintined gardens are at the rear of the home and many residents reguarly spend time in the garden. St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A planned unannounced inspection took place on 15 August 2005 and 16 August 2005. The purpose of the inspection was to consider some of the key standards that included assessment and care planning, health and safety and staffing arrangements. One of the registered providers, residents and staff were consulted about the services and facilities provided. The environment, records and documents were also considered. The provider, staff and residents fully cooperated and were very helpful throughout the inspection period. What the service does well:
Prospective residents and their relatives or representatives are able to visit the home to help them decide if it is a suitable place to live. The visiting arrangements are flexible according to the individual’s choice. For residents living at the home the visiting arrangements are also flexible and they decide where they meet with their visitors. The providers are keen to make sure that personal relationships with family and friends are encouraged. Residents commented that visitors are warmly welcomed at the home by the providers and staff. Residents said they felt in control of their lives at the home and had confidence in the way staff provide the care and support they require. Residents commented they were able to direct the care and support required and that staff treat them in a respectful and dignified manner. A suitable policy and procedure is in place for positively dealing with any complaints the residents may have. Residents commented there were no barriers to discussing any concerns or complaints with the providers. The residents were confidant that any issues would be acted upon promptly and resolved in a satisfactory manner. The home is decorated, furnished and maintained to a high standard and residents said they were very satisfied with the facilities provided. Many of the residents’ bedrooms have been personalised by the occupants and a good standard of furnishings and furniture is provided. Regular maintenance occurs at the home and the residents were very positive about the efficient service provided when any repairs were required. A number of bathrooms and toilets are located throughout the home and many of the bedrooms have ensuite facilities. Attractive and well maintained and stocked gardens are located at the rear of the home and this is a popular area for many residents. Appropriate communal space is also located on the ground floor. Residents said the home was clean and hygienic and no offensive odours were present. The home doe not have any sluice facilities and these need to be
St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 6 installed at the earliest opportunity. The flooring on the first floor also requires attention to make sure it does not present any form of risk to residents. Sufficient number of staff is employed during waking hours and overnight. Additional staff are on duty for peak hours during the daytime and waking night staff work each night. A staff member also sleeps in to assist with any emergencies and the providers have established reliable on call arrangements. Residents commented they are very satisfied with the way in which staff undertake their duties and provide the care and support they require. The residents said that staff are flexible, readily available and attentive to their needs. Staff commented they were very supported at the home and good team working practices occurred. Positive recruitment practices are in operation and generally the providers have well maintained records as required by the Care Homes regulations 2001. The vetting arrangements require improvement so that staff do not commence working at the home until the required checks have been completed. This will make sure that residents are not placed at risk. Residents commented the home is very well run by the providers and they are regularly consulted about the services and facilities provided. The providers take the lead role in the running of the home and also regularly consult with the staff group. What has improved since the last inspection? What they could do better:
Each prospective resident is assessed by the providers to find out their needs and make sure the home can provide the care and support they require. The assessment need to be more detailed about the prospective residents needs and preferences about the care and support they require. The records also need to demonstrate the views of any professionals that are involved with the individual and that the person’s relatives or representatives have been consulted. Each resident has a care plan that is regularly reviewed with the resident concerned. In some care plans clear information is recorded about the most appropriate way to provide the care and support the residents requires. There are other examples where the residents needs are summarised but do not provide clear guidance about the best ways of providing the care and support
St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 7 they need. In this situation staff are not provided with adequate guidance and direction about meeting residents needs, preferences and choices. The providers treat any allegations of abuse seriously and all instances are reported to the statutory authorities and where necessary are formally investigated. The policy and procedure about protection does not reflect the steps the providers would take and therefore requires improvement. Satisfactory whistle blowing arrangements are also in place for staff to report any concerns to a third party if they feel unable to discuss the matter with the providers. This provides residents with further protection against abuse. There are some good examples of records keeping at the home but other records need to be improved. The records are held securely and are available to the staff. The staff regularly consults the records to help them meet the needs of residents and provide a safe environment. The risk assessment arrangements require improvement to make sure that every reasonable step is taken to protect the well being of residents and staff. All accidents and incidents are formally reported but the records could be more detailed to help eliminate any potential risks. The storage facilities at the home are inadequate and require improvement. This will make sure there are no potential hazards around the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5 The assessment arrangements need to be improved in order that the providers are able to make sure they can meet the residents’ care and support needs. Good arrangements are place for prospective residents to visit the home to help them decide if it is a suitable place to live. EVIDENCE: The records of residents that have recently moved to the home showed that the providers undertake an assessment to make sure they are able to meet the needs of the person concerned. The assessment summarises the individuals needs but could be more detailed and include the prospective residents choices and preferences about the care and support they require. There was no documentary evidence to indicate the prospective residents relatives or representatives were consulted but Mr Maund commented that relatives were always invited to fully participate in the assessment process. There were also no records to indicate the views of any professional involved with the prospective resident had been taken into account. Prospective residents and their relatives or representatives are invited to visit the care home to help them decide if it is a suitable place to live. The visiting
St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 10 arrangements are flexible and reflect the persons preference and choice about the best way to be introduced to the home. Residents that have recently been admitted to the home commented they had been warmly received and the providers and staff who had positively helped them to settle. St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 9. The care planning arrangements need to be improved in order that staff are provided with appropriate advice, guidance and direction about the care and support required by the resident. The arrangements for the administration of medicines also require improvement to make sure that residents are not placed at risk. EVIDENCE: Each resident has a care that summarises the care and support they require. The staff said they found the plans to be helpful and to guide the care provided to residents. Residents commented they were very satisfied with the manner in which staff undertake their duties and found the staff to be flexible and responsive to any requests they made. The information provided in the care plans could be improved in certain instances. Some of the care plans provide the staff with clear information, direction and guidance about the resident’s needs and most appropriate way to provide the care and support required. Others summarise the needs and care required but are unclear about the most appropriate way to meet the need in a manner that promotes the residents wellbeing and reflects the individual’s preferences and choices.
St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 12 The records demonstrate that care plans are reviewed with the residents on a regular basis. Medicines are stored securely and the policy and procedure about the administration of medication has recently been updated. Residents are able to administer their own medication when it is safe to do so. Where a resident wishes to administer their own medicines the providers complete a risk assessment in consultation with the persons General Practitioner. It is recommended the format for recording this assessment of risk be improved in order that a clear picture can be provided about how the decision was reached. The staff responsible for administering the medication have all been appropriately trained and suitable arrangements are in place to dispose of unwanted medicines. The records about the administration of medication are not always completed and staff do not have a consistent approach to the records about medicines that are prescribed as and when necessary. Two staff do not also sign the record where a General Practitioner has stopped or started a medication and there appear to be no additional records of who has directed the staff to take this course of action. St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 14. The flexible visiting arrangements at the home are positive and residents decide where they meet with visitors. Residents are able to make decisions and have control over their lives. EVIDENCE: There are flexible visiting arrangements at the home and contact with residents by family, friends and representatives are encouraged by the providers. Residents commented that visitors receive a warm welcome from the staff and the residents are able to decide where they meet with their visitors. The providers will also support any resident that decides not to meet with a visitor. Residents also said they felt in control of their lives at the care home. Staff treat residents with dignity and respect and carefully listen to and act upon residents choices, preferences and decisions. Residents were confidant they were able to direct the care and support the staff provided and said they were regularly consulted about the running of the care home. St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. Positive arrangements are in place to deal with any complaints or concerns residents may have. The arrangements for protecting residents against abuse are robust but the policy and procedure is not satisfactory. EVIDENCE: The care home or the Commission following the last inspection has received no complaints. The providers have established a satisfactory policy and procedure for dealing with complaints and are committed to resolving any concerns at the earliest opportunity. Residents commented there were no barriers to approaching the providers about that any issues, concerns or complaints they had. The residents also said they were confidant that any issues would e dealt with promptly, efficiently and resolved in a satisfactory manner. The records show the providers have a clear understanding about the action to take if any allegations are made about abuse to residents. All allegations are reported to the statutory authorities and where necessary a formal investigation takes place. The policy and procedure does however require amendment, as it does not accurately reflect the steps the providers would take or the guidance provided by the Department of Health. The providers have also established satisfactory whistle blowing arrangements. This provides staff with the opportunity of reporting any issues to a third party where they feel unable to report the matter to the providers. This provides residents with a further safeguard against abuse. St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21 and 26. The standard of the environment within this home is very good and provides residents with an attractive and homely place to live. However the floor on the first floor require attention to make sure that residents health and well being is not compromised. The home is clean and hygienic but sluice facilities need to be provided to also make sure residents health is not compromised. EVIDENCE: The home is maintained to a high standard and an annual programme of maintenance and replacement of equipment and furniture is in place. Residents commented they were very satisfied with the facilities provided and said the providers responded promptly and efficiently to any repairs that were required. There are also very well maintained and attractive gardens at the rear of the home that is a popular area for many of the residents. A car park is also provided at the rear. Residents also said they were very satisfied with their bedrooms. The bedrooms are situated on the ground and first floors and have been personalised by the occupants and a good standard of furnishings and furniture
St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 16 is provided. Residents are able to lock their rooms if they wish and secure facilities are also available within their rooms. A range of toilets and bathrooms are provided throughout the care home that meets with the national minimum standards and many of the bedrooms also have ensuite facilities. The floors on the first floor are unstable in certain parts and require attention or replacement to make sure that residents and staff are not placed at risk. The providers have taken steps to ensure that a range of disability aids and equipment is provided at the home to help residents maintain their independence but the home does not have any sluice facilities. Theses facilities need to be provided to make sure that residents health and wellbeing is protected from infection. The home is clean and hygienic and no offensive odours were evident. Residents said they were very pleased with the standard of cleanliness provided. St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29. Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. Positive recruitment practices are in place but new staff are not always satisfactorily vetted before they commence employment. This could place residents at risk. EVIDENCE: The records show that minimum staffing levels are maintained during waking hours and over night. Additional staff is on duty during peak hours of the day and waking night staff are employed each night. In addition a staff member sleeps at the home each night to assist with any emergencies that may occur. The providers have also established reliable on call arrangements in order that they can provide additional support when necessary. Residents commented they were very satisfied with the manner in which the staff meet their needs and provide the support they require. The residents said that staff were readily available, flexible and thorough in respect of all their duties and responsibilities. The residents have confidence in the staff and are complimentary about the quality of service they provide. Staff commented on the positive teamwork and mutual support that occurs at the home. The staff said they were well supported by the providers and senior staff and that advice, guidance and assistance was always available. One staff member described the providers as “empowering” and commented on the range of opportunities that had been provided to improve and develop their skills and experiences in care.
St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 18 The records show that positive recruitment and selection and arrangements are in place but not all of the documents that are required by regulation were available for inspection. Some staff had also commenced employment before a satisfactory POVA check had been completed and this does not comply with the Care Homes Regulations 2001. It is also recommended that the application form include a statement from applicants about any criminal convictions they have had in the past. St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 37 and 38. The home is well managed and run by the providers for the benefit of the residents. The records at the home are generally good but some require improvement. This will make sure that residents needs are met and that residents or staff are not placed at risk. EVIDENCE: Residents commented the home is well run and the providers regularly consult with them about the services and facilities provided. The providers take the lead role in the management of the home and regularly meet with staff to consider the quality of the services provided. Staff commented there are no barriers to raising any issues or suggestion for improvements with the providers and any comments are positively received and considered. To assist in the day to day operation a management team have been established that includes a Deputy Manager and Team Leaders. A member of
St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 20 the management team is on duty for all waking hours and one team leader has responsibility for the night care staff. The staff said the managers were also approachable, supportive and provided guidance and assistance when required. The records at the care home are in good order generally although certain records could be further improved. This can be illustrated by the previous comments in this report about assessment and care planning. The records are stored safely and accessible to the staff. The staff regularly uses the records available to assist them in their duties and to meet the needs of residents. There are no barriers to residents accessing their records if they wish. Daily records are kept for each resident. The records detail the events that have occurred; any incidents and any action the staff has taken. Some of the records also state the outcome of the action. The providers have established a range of policies and procedures to promote safe working practises. All staff has a rolling programme of training about health and safety issues. The records show that equipment and services to the home are regularly maintained and serviced. The Fire Brigade have recently inspected the home and found the arrangements in place to be satisfactory. The storage facilities at the home are not adequate and this could be a potential risk to residents. The providers are aware of this difficulty and are actively considering steps to provide additional storage space. Any accidents that occur at the home are formally recorded but in some instances the records could be improved to provide more detail of the circumstances of the accident or incident. This will help to minimise the potential risk to the person concerned in the future. Where a potential risk applies to an individual resident a risk assessment is completed. A suitable format for recording the assessment has been established but the recording practices require improvement. The assessments do not always provide sufficient detail or clearly outline the action the staff are required to take to minimise the risk to themselves or the resident concerned. St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 2 x 3 x x x x 2 STAFFING Standard No Score 27 4 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 4 x x x x x 2 2 St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 14 Requirement Each prospective service user must be comprehensively assessed and the views of the professionals involved taken into account. Care plans must provide sufficient detail to guide, direct and inform the staff about the most appropriate ways to meet a service users needs. The records about the administration of medication (MAR sheets) must always be completed. Sluice facilites must be provided. The floors on the first floor must be replaced or repaired to make sure that service users are not placed at risk. Staff must be POVA checked before thye commence any work at the care home. The records at the care home must comply with the Care Homes reguations 2001. Sufficent storage space must be provided at the home. The records about managing risk at the home must detail the events that have occurred, the assessment of risk and any
D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Timescale for action 30.12.05 2. 7 15 30.1.06 3. 9 13 30.9.05 4. 5. 26 19 13 13 30.12.05 30.12.05 6. 7. 8. 9. 29 37 38 38 19 17 13 13 30.10.05 30.3.06 30.12.05 30.11.05 St Clair House Care Home Version 1.40 Page 23 action required by the staff to minimise risks in the future. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 2 9 9 Good Practice Recommendations The views of prospective residents relatives or representatives should be recorded as part of the homes assessment arrangements. The risk assessment records for service users administering thier own medication should be improved. Where staff make a record on the MAR sheet of an adjustment to a service users medicines a record should be made of who directed the change and be signed by two staff members. The application form for new staff should include information about any criminal convictions that applicant has. Service users daily records should state the outcome of any action that staff have undertaken. 4. 5. 29 37 St Clair House Care Home D52-D04 S41642 St Clair House V231498 150805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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