Inspection on 09/03/09 for St Clements Nursing Home

This inspection was carried out on 9th March 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Clements Nursing Home 07/03/07

St Clements Nursing Home 24/01/06

St Clements Nursing Home 26/07/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Clements Nursing Home 170 St Clements Hill Norwich Norfolk NR3 4DG     The quality rating for this care home is:   one star adequate 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: Jane Craig     Date: 0 9 0 3 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 28 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 28 Information about the care home Name of care home: Address: St Clements Nursing Home 170 St Clements Hill Norwich Norfolk NR3 4DG 01603427487 01603789407 govinden@providencehealth.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Providence Health Care Limited care home 25 Number of places (if applicable): Under 65 Over 65 25 old age, not falling within any other category Additional conditions: 0 One person under the age of 65 who will be named in the Commissions records. Date of last inspection Brief description of the care home St Clements was built in 1947 and sits within close proximity to Norwich city centre. An extension was built to increase the accommodation in 1989. The well-tended garden extends out the back of the property in approximately half an acre. The home has accommodation for 24 older people with access to the ground floor and first floor by a passenger lift. The home is suitably adapted to cater for people with varying disabilities in either double or single bedrooms. There is a lounge with an added conservatory, which is used as a dining facility when required. A library, hairdresser and chiropodist visit the home on a regular basis. Information about the home is sent out to anyone making enquiries. The latest inspection report is on display in the home. In March 2009 the weekly fees for the home ranged from 462 to 700 pounds. Care Homes for Older People Page 4 of 28 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: one star adequate 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: The last key inspection on this service was completed on 7th March 2007. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 9th March 2009 by one regulatory inspector. At the time of the visit there were twenty one residents in the home. We met with some of them and wherever possible asked about their views of St Clements. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. Care Homes for Older People Page 5 of 28 We talked to the registered manager, the deputy manager, staff and visitors. We looked around the home and viewed a number of documents and records. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. What the care home does well: What has improved since the last inspection? What they could do better: The care plans must always be brought up to date whenever the residents needs change, so that staff can be sure they are giving the right care. The plans should be more detailed and individual to the resident so that staff know exactly how they wish to be supported. Hazards to residents health and safety caused, for example, by the use of bed rails, must be assessed and plans must be drawn up to try to minimise the risk. So that staff can be sure that residents are receiving their medication as it is prescribed the records must be kept up to date. Staff should review some of the practices in the home to make sure that residents Care Homes for Older People Page 7 of 28 have as much choice as possible in their daily lives and routines. All staff must be clear about what to do if they believe a resident has suffered abuse. They must be clear about their role and how to report it to the appropriate agencies to ensure it is dealt with correctly. To give people a choice of bathing facilities the bathrooms should be cleared of equipment and made completely accessible. There should also be more toilet facilities near the communal areas. 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. 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 8 of 28 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 9 of 28 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. Prospective residents were not admitted to the home unless their assessed needs could be met. Evidence: People thinking of moving into the home were given a service users guide. This had recently been updated and provided comprehensive information about what people could expect from the service. One resident said that her daughter had received a booklet that told her all about the home. Residents were assessed prior to being offered a place at the home. This practice helped to ensure that the prospective residents needs were understood and that St Clements could provide the support they needed. The pre-admission assessment document highlighted the prospective residents level of independence or dependence in various activities of living. There was room for staff to add comments but the one Care Homes for Older People Page 10 of 28 Evidence: we saw provided very little information about the individual. A more detailed assessment, which identified the residents routines, preferences and wishes was carried out on admission. The initial care plans were drawn up from this assessment. Standard 6 was not applicable as St Clements did not provide intermediate care. Care Homes for Older People Page 11 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all care plans provided staff with the information they needed to meet residents personal and health care needs. Potential risks to residents health were not properly assessed and controlled. Evidence: We looked at three sets of care records as part of the case tracking process and others were looked at to check specific issues. Most of the care plans we saw were standardised and contained only vague directions. For example, plans to assist people with their personal care needs were exactly the same for each resident. This meant that staff were not given any instructions on how to support people in accordance with their preferences or in a way that maximised their independence and choice. The exception to these were night care plans which told staff exactly what care the resident needed throughout the night. Residents or their relatives were invited to sign their agreement to the plans but it was not clear how input they had in drawing up the plans. Care Homes for Older People Page 12 of 28 Evidence: A number of residents had care plans that had been in place since their admission. These had been reviewed every month but not always thoroughly. For example, there were notes to show that the care plan for one person had been reviewed every month but it had not been picked up that staff were using the wrong name. Another plan we saw instructed staff to monitor the residents blood sugar level every six hours. The records showed that this had been altered to twice a day but the plan had not been amended. The lack of accurate and up to date information could result in residents being given the wrong care. Most of the residents we spoke to made positive comments about the care they received. One said, They wash and keep me nice and comfortable. Another commented, If you ask them they will do anything for you. Relatives also told us they were satisfied with the care. One said, I know he is well looked after and I am not worried about leaving him. Records showed that residents ongoing health care needs were monitored and they were referred to health care professionals as necessary. One visiting professional said that the service provided good basic nursing care and staff knew peoples needs very well. There were some health care risk assessments on the files. Those for moving and handling were good. However, others were not specific enough and only gave vague directions which could result in misunderstandings and inconsistencies in care. Risk management plans were standardised and did not address hazards specific to the individual. For example, one person had a significant number of falls over the past few months. They did not have a falls risk assessment and their care plan was the same as one for someone who was at low risk of falling. The AQAA told us that all residents had a thorough nutritional risk assessment but these were not on any of the files we looked at. Everyone was weighed regularly and there was evidence that anyone who was losing weight was referred to their GP but care plans were not always changed to show that staff were monitoring the situation more closely. The majority of residents had bed rails in place. None had been assessed to find out whether the use of bed rails was appropriate. There were no assessments to show that the bed rails used were suitable for the resident, the bed and the mattress. There were no ongoing maintenance checks to ensure that the rails were safe. None of the residents administered their own medicines. Safe systems were in place Care Homes for Older People Page 13 of 28 Evidence: for ordering medication. There were complete records of medicines received and disposed of, which assisted with the audit trail and reduced any risk of mishandling. There were occasional gaps on medication administration record (MAR) charts. The corresponding medicines had been removed from the blister pack, which indicated that they had been administered but not recorded. Some residents were prescribed creams, which were applied by the care staff. These were not signed for, which made it difficult to know whether they were being applied consistently. Some residents were prescribed medicines to be taken when required. There were no care plans to direct staff when these should be given. This lack of guidance could increase the risk of over or over medicating. Handwritten entries on MAR charts accurately reflected the instructions on the medicine containers and special instructions were recorded. Some entries had been witnessed but not all, which increased the risk of transcribing errors. Controlled drugs were stored, recorded and administered safely and according to the policy. The service users guide included information about how core values, such as privacy, dignity and independence would be promoted at the home. Staff received training during their induction and they were able to describe some of the ways they ensured residents rights to privacy were upheld. During the visit we observed staff speaking politely to residents and treating them with respect. One resident said that it was a little embarrassing having staff help him to bathe but they were very professional about it, which helped. Care Homes for Older People Page 14 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not everyone using the service had sufficient choice and control over their lives or had their social and recreational needs met. Evidence: Most residents had a life story document on their files. This contained details about their family, past and present interests and their likes and dislikes in a variety of areas. Although the information was not used to draw up social care plans, staff told us that they used the life stories as topics for discussion with residents. One said that knowing about the resident helped staff if they had to make choices on their behalf. Staff told us that residents had choices in most aspects of their daily lives but there were indications that some practices were staff led. For example, there were set rotas for bathing and regimes for taking people to the toilet. Everyone ate their meals from a small table in their bedrooms or in the lounge. Staff said this was the choice of the residents but there was only one table available for communal dining and this was not set, which would make it difficult for residents to choose to eat at the table. The majority of the residents were given hot and cold drinks in plastic beakers and many of these had lids on. Although some residents had obvious difficulties and would not be Care Homes for Older People Page 15 of 28 Evidence: able to hold an ordinary cup, this was not the case for everyone and the use of plastic cups would not necessarily be their choice. Similarly most residents went to bed very early. Staff said this was their choice but this may be an example of a routine introduced by staff, which residents went along with. None of the residents we case tracked had a care plan to support them to meet their social and recreational needs. The home employed an activity co-ordinator, who organised a group activity four days. There was no set programme and she said the activity of the day was based around the interests and abilities of the residents who were joining. She tried to spend some time with residents who were not able or did not want to join in groups, either talking in their rooms or taking people out. The records of activities were not up to date therefore it was not clear whether residents needs were met. Those we spoke to had mixed views. Some said they did nothing all day and told us it was boring. Others confirmed that staff went in to talk to them when they had time. There was a four week rotating menu, which included some suggestions from residents. There was a choice at each meal and records showed that residents were offered a varied and balanced diet. Residents we spoke with said they were satisfied with the meals. Comments included, The foods not bad at all, we get a good choice, Food is very important to me and it is very good here, and If I dont like it I send it back and I get something else. The service had received four out of a possible five stars following an environmental health inspection of the kitchen and food systems last year. Care Homes for Older People Page 16 of 28 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. People using the service were confident that complaints would be dealt with appropriately. The lack of clear procedures for reporting suspected abuse could result in allegations being mishandled. Evidence: The complaints procedure was on display in the home and all residents received a copy in their service users guide. The procedure told people exactly how they could expect their complaint to be dealt with and gave the timescales for response. A previous recommendation to record minor complaints had been acted upon. They had received two in the last year and these had been looked into and resolved immediately. A relative confirmed that when they had made staff aware of a minor problem it had been put right. Residents said they would speak to their families or to staff if they were unhappy about the service or had a complaint. There had been no formal complaints in the past year. New staff received training in safeguarding during their induction and there were regular refresher courses. The Norfolk County Council procedure for the protection of vulnerable adults was available for reference purposes and the home also had their own procedure. This gave staff useful information about prevention and detection of abuse. However, the directions for dealing with an allegation were not clear, which could lead staff to exceed the boundaries of their role. Not all the senior staff we spoke Care Homes for Older People Page 17 of 28 Evidence: to were completely clear about the role of social services in investigating abuse. The service had not had any safeguarding issues since the last key inspection. Care Homes for Older People Page 18 of 28 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. The home provided residents with a comfortable and pleasant place to live. Evidence: The home was generally well maintained. There was a system for flagging up minor repairs, which were carried out quickly. Safety measures such as window restrictors and radiator guards were in place. The AQAA told us that there had been some improvements to the environment in the past year. Some of the old metal window frames had been replaced and some areas had new carpets. Whilst looking round the building we identified some bedrooms and corridors that were in need of attention. The manager told us that redecoration and renewal of the home was ongoing but there was no plan with timescales for action. This meant that we could not be sure that these areas had been identified and when they would be addressed. Before the end of the visit the manager arranged for an outside consultant to undertake an audit of the environment and draw up a plan of action. Those residents we asked said they were satisfied with their rooms. Many rooms were personalised with ornaments, pictures and small items of furniture. One resident told Care Homes for Older People Page 19 of 28 Evidence: us they liked their room because it was spacious and they had their own toilet which was a bonus. Another said they chose their room because of the view of trees and flowers. On the day of the visit two of the bathrooms were cluttered with mobile commodes, weighing scales and linen receptacles, which meant they could not be used safely by residents. Two of the three downstairs toilets had staff only notices on them. This meant there was a shortage of toilets for residents in the communal areas. At the time of the inspection the home was clean and free from unpleasant odours. Residents and relatives said this was always the case. One said, It is always clean, they havent done it especially for you. The AQAA indicated that the home had an action plan for delivering best practice in relation to infection control and that all staff had received training in this area. Staff we spoke to talked about the importance of universal precautions, especially hand washing. However, a number of bathrooms and toilets did not have toilet rolls, liquid soap or hand towels. The manager rectified this immediately. Only personal clothing was laundered on the premises and the laundry was adequately equipped for this. Care staff were responsible for doing the laundry but the manager said the amount did not intrude on their care work. There were no complaints about the laundry during the visit. Care Homes for Older People Page 20 of 28 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. Residents were protected by the recruitment practices and there were sufficient staff, with appropriate training, to meet their needs. Evidence: The staffing numbers had recently reduced because of a slight fall in the occupancy level of the home. Staff said there were still enough on duty to meet the residents needs and the residents we spoke with confirmed this. One said, Its hard to say whether there are enough staff but they come if you ring the bell. Another told us, When I ring the bell they come as quick as anything. We looked at the files of two recently appointed staff. They had been recruited in accordance with the procedure for the home. All pre-employment checks had been carried out but not all documents had been retained for one of the staff. New staff went through a very thorough induction training programme. They had an initial induction to orientate them to the environment and then completed a workbook that covered the standards set by the national training organisation. At the end of each section the member of staff had a written assessment and had their practice monitored by their mentor. One member of staff told us it took about three months and there was a lot of training but it was good. Care Homes for Older People Page 21 of 28 Evidence: Staff also said there were good opportunities for further training and they attended a range of in-house and external courses. Training in the safe working practice topics was up to date, which helped to protect the health and safety of both residents and staff. The AQAA told us that most of the care staff had attained the NVQ level 2 in health and social care, which helped to ensure they had the basic knowledge and skills to understand and meet the needs of the residents. Care Homes for Older People Page 22 of 28 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 was run in the best interests of the people living there but minor shortfalls in health and safety practices could place people at risk of harm. Evidence: The registered manager, a registered nurse with qualifications in management and teaching, had supernumerary status. During discussions he told us he had delegated a number of day to day management tasks to the deputy manager to enable him to work on future development of the service. The deputy was in the process of undertaking the recommended management qualification but did not have as much experience in managing services. The deputy manager had some supernumerary time but also worked some of her shifts as the registered nurse in charge of the home. At the time of the visit it was not completely clear what the roles of the registered manager and the deputy were. We discussed with the registered manager that this lack of clarity of roles and period of change could account for the fall in standards in some of the areas that achieved an excellent or good rating during the last key Care Homes for Older People Page 23 of 28 Evidence: inspection. There were some systems in place to monitor the quality of the service. Annual satisfaction surveys were sent out to residents, relatives and visiting professionals. The questionnaires for this year had been returned but not yet collated and published. Records of resident and relative meetings showed that people were informed about anything going on in the home and were invited to make suggestions for changes. We were told that a manager from another home carried out an annual audit of systems and procedures but this had not been done since December 2007. Action plans had been drawn up to address any suggestions from surveys, meetings or the audit but there were no records to show that the actions had been carried out. Residents, who were able to, managed their own finances. Others had support from their family or appointee. Small amounts of money were held for safekeeping for a number of residents. There were clear records and receipts to show all transactions made on behalf of the residents. These were audited annually. We looked at a small sample of records and found that they corresponded with the money held in the safe. A recommendation had been made at the last inspection to audit falls and identify any potential patterns and put appropriate preventative measures into place. This had not been actioned. One resident had a number of unwitnessed falls but their care plan did not reflect any special monitoring. There was a list of recommendations from the fire risk assessment but there were no records of completion. However, it was apparent from looking round and talking to the manager and staff that at least some had been met. Staff had received fire safety training and those we asked were clear about the procedure to follow in the event of a fire. Fire alarms were tested regularly and other fire safety equipment had been serviced. A resident told us, They are very good about fire fighting things, it makes me feel safer. The AQQA showed that the maintenance and servicing of most equipment and installations in the home were up to date, which helped to protect the health and safety of people living and working in the home. However, the tests of portable electrical appliances was overdue. The manager was aware of this and said he had arranged for it to be done. Care Homes for Older People Page 24 of 28 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 25 of 28 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 7 15 Care plans must be reviewed 30/04/2009 and amended as and when the residents needs change. To ensure that the resident receives the appropriate support. 2 8 13 Risks associated with falls, 30/04/2009 poor nutrition and the use of bedrails must be assessed and plans drawn up to reduce the risk. To promote the residents health and safety. 3 9 13 There must be complete and 31/03/2009 accurate records of all medication administered to residents. To promote their health and to continue the audit trail. 4 38 13 Portable electrical appliances 30/04/2009 must be tested in accordance with health and safety legislation. Care Homes for Older People Page 26 of 28 In order to protect residents and staff. 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 Care plans should be individualised and contain sufficient detail to ensure that residents receive the care they need in the way that takes into account their preferences and wishes. There should be clear criteria to guide staff when to give when required variable dose medication. Handwritten entries on MAR charts should be checked to reduce the risk of transcribing errors. Each resident should have a care plan to support them to meet their social and recreational needs. Routines in the home should be reviewed to ensure that, as far as possible, they are for the benefit of residents and not staff. The safeguarding procedure should have clear guidance on reporting suspected or actual abuse outside the home. Equipment should be cleared out of the bathrooms to make them accessible to residents. 2 9 3 4 12 14 5 6 18 19 Care Homes for Older People Page 27 of 28 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). 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