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Inspection on 08/08/05 for St David`s Nursing Home For Disabled Ex-servicemen and Women

Also see our care home review for St David`s Nursing Home For Disabled Ex-servicemen and Women for more information

This inspection was carried out on 8th August 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users and representatives feedback indicated that the staff are caring and approachable. Staff are instructed in caring for service users in a competent, courteous and gentle manner, this was reflected in the comments from the service users and observations at the inspection. Service users are fully assessed prior to admission to ascertain if the home can meet their needs. The food provision is of a good standard, with varied choices available. There is a content, homely atmosphere throughout the home, and the management is always looking for new ways to improve the service provision, which is already of a good standard. Management is strong and effective with an open approach and clear direction.

What has improved since the last inspection?

Work has taken place to access and set up named bank accounts for service users. The system of formal supervision for nursing and care staff is now up and running, plus staff in all departments receive regular supervision, which is good practice. Fire drill records identify that night and day drills are now taking place, thus keeping all staff up to date with the procedures to be followed. The improvement in the completion of staff employment records has been maintained since the last inspection.

What the care home could do better:

Some areas of the service user plans had shortfalls, but these should be easily addressed. Staff must then work to maintain the service user plans in an accurate and up to date condition thereafter. The main area of concern was the management of the medications. Action must be taken to address the current shortfalls and thereafter to introduce measures to ensure that the management of medications in the future is robust.

CARE HOMES FOR OLDER PEOPLE St Davids Nursing Home for Disabled Exservicemen and Women Castlebar Hill Ealing London W5 1TE Lead Inspector Clare Henderson-Roe Unannounced 8 & 9 August 2005 10:40am th th 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 Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St Davids Nursing Home for Disabled Exservicemen and Women Castlebar Hill Ealing London W5 1TE Address 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) 0208 997 5121 0208 997 2447 St Davids Nursing Home for Disabled Exservicemen and Women Mr Barrie Taylor Care Home 40 0 Category(ies) of PD - Physical disability 0 OP - Old age registration, with number PD(E) - Physical disability (over 65) 0 of places St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Service users to include 40 service users over the age of 40 years. Date of last inspection 13th October 2005 Brief Description of the Service: St David’s Nursing Home is situated in spacious grounds in a residential area of Ealing. The home is accessible by bus and the nearest underground and mainline station is Ealing Broadway. The home has a central courtyard that provides a pleasant area in which service users and their visitors can sit. A new decked area has been created outside one of the communal rooms and this affords another attractive seating area for service users and their visitors. The home provides nursing care for 40 ex-service personnel. The accommodation consists of 32 single rooms, two with en suite facilities, and four double rooms. There are spacious communal sitting and dining rooms and a designated smoking area. St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 9 hours were spent on the inspection process. The Inspector carried out a tour of the home, and inspected administration, staffing and fire safety records, plus 3 service user plans. 5 service users, 5 visitors and 7 staff were spoken with as part of the inspection process. What the service does well: What has improved since the last inspection? What they could do better: Some areas of the service user plans had shortfalls, but these should be easily addressed. Staff must then work to maintain the service user plans in an accurate and up to date condition thereafter. The main area of concern was the management of the medications. Action must be taken to address the current shortfalls and thereafter to introduce measures to ensure that the management of medications in the future is robust. St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 6 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 Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 5. The home does not provide intermediate care. Service users are assessed prior to admission to ensure the home can meet their needs. Prospective service users and their representatives are encouraged to visit the home in order to allow them to make an informed choice. EVIDENCE: A pre-admission assessment is carried out for all prospective service users. Samples of these were viewed and these were comprehensive and had been clearly completed. For some service users, a copy of the Social Services assessment is obtained. The home does ascertain if it is able to meet the needs of prospective service users. Prospective service users and their representatives are encouraged to visit and view the home prior to admission. Feedback from service users and visitors confirmed that staff take time to provide information and to answer any queries in an unhurried and clear manner. A copy of the Service User Guide is given or sent out to prospective service users also. St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 9 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, 8, 9 & 10 Service user plans were not always personalised and up to date, and this can place service users at the risk of not having their needs fully met. Shortfalls in the management of medications potentially place service users at risk. Staff are courteous to service users and personal care is provided in such a way as to promote and protect the service users privacy and dignity. EVIDENCE: Three service user plans were viewed. Two had been personalised to the service user and gave a comprehensive picture of their assessed needs and how these were to be met. One was very general with some inaccurate information, as the service user plan had not been updated when the service user was readmitted to the home following a hospital admission. Risk assessments for falls were in place and there was evidence of these being updated following any falls. For one service user who wished to have hot water for use when shaving, a risk assessment was to be formulated. There was evidence of monthly updating of the service user plans. Documentation for wound care was in place. For one service user, three wounds had been recorded on one progress document, and it was St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 10 recommended that separate documentation be completed for each wound identified. There was evidence of input from the tissue viability nurse specialist. Pressure relieving equipment was in use in the home, and service users had been assessed to ensure the correct equipment to meet their needs was in place. Care plans for continence care needs were in place, but in two instances continence assessments had not been completed. It was also noted that there is no space for staff signatures and the date of completion to be recorded on the continence assessment document. Moving & handling assessments were in place, one of which needed to be completed. Nutritional assessments were in place. Risk assessments for bedrails had been completed, but some required more information to identify clearly the appropriateness of the use of bedrails in each instance. Consents for the use of bedrails are incorporated with the assessment and had been signed by the service user or their representative. There was recorded evidence of service users receiving input from the GPs and other health care professionals. Medications for five service users were viewed. There were omissions in the recording of receipt of some medications, and also gaps in administration records noted. Stocks of medications did not always match with the number of tablets administered from the box. One medication had been out of stock for 7 days before a new stock was obtained. The evening dose of one medication had not been signed for 19 days, although the medication had been administered from the blister pack. For one controlled drug, one dose had been recorded as ‘missing’ and no investigation had been carried out to follow up this finding. The shortfalls identified gave cause for concern and were discussed with the Registered Manager. A full audit of the medications was carried out on the morning of the second day of inspection prior to the Inspectors visit and an action plan to address the shortfalls identified had been drawn up. The Registered Manager agreed to carry out his investigation into all shortfalls identified and forward the findings together with the ongoing action plan to the CSCI on 18/08/05. Staff were seen to care for service users in a gentle manner and address them with courtesy and respect. Service users and visitors spoken with expressed their satisfaction with the care provided at the home. Service users can have their own telephones if they wish and there is access to the home telephone also. Service users individual clothing is clearly and discreetly labelled for identification. Screening is available in the double rooms. Service users see healthcare professionals in the privacy of their own bedrooms. St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 11 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, 14, 15 and aspects of standard 12. Social activities are provided to meet the service users interests, thus improving their quality of life at the home. Visiting is encouraged and this enhances the service users lives and keeps them in touch with their families and friends. Service users are encouraged to exercise their independence wherever they are able, to maintain their quality of life. The meal provision is of good quality, with alternatives being available, to meet the nutritional needs of the service users. EVIDENCE: Social activity interest lists had been completed for service users. The information gained assists with the formulation of activities programmes to meet the service users interests. Outings are arranged and the home has its own minibus for this purpose. On the second day of inspection entertainers who interact with the service users as part of their presentation were providing entertainment for the service users. This is a regular activity, every two weeks, and is enjoyed by the service users. A barbeque had recently taken place, and there was evidence of various interests and hobbies being pursued by service users. The Registered Manager said that he is still working on the weekend activities provision, and this will be reviewed at the next inspection. St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 12 The home has an open visiting policy and service users can receive visitors in their own rooms or in one of the communal areas. Several areas are available for service users to receive visitors in private. The Registered Manager said that if there were any issues with service users not wanting a particular visitor, then this would be recorded and managed, with the service users input and agreement. Visitors spoken with said that they are made welcome by staff at the home. Where possible, the service users next of kin or representative manage any finances where service users are unable to do so. Information regarding advocacy services is available in the home. Bedrooms viewed had been personalised to give them a homely feel. The kitchen was clean and tidy and daily fridge and freezer temperatures are recorded. Cleaning records were up to date. The menu reflects the preferences of the service users and offers a choice of two main meals. The evening provision has been reviewed and in addition to soup and sandwiches, freshly cooked meals to order are available. The lunchtime meal to include liquefied food was well presented and service users spoken with said that they enjoyed the food provision at the home. The meal sampled was well presented and tasty. The chef has attended training specific to specialist nutritional requirements and was very clear regarding the provision of meals for service users with medical requirements, such as diabetes. The chef was very aware of the correct cooking procedures and presentation methods for different foods. The lunchtime meal was unhurried and staff were available to assist service users as required. It was clear that the chef and his staff take pride in their work. St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 13 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, 17 & 18 The home has a satisfactory complaints system with evidence that concerns are listened to and acted upon. Service users rights are protected and service users are able to exercise their legal rights directly. Staff did not always have a clear knowledge of protection of vulnerable adults procedures, which could place service users at risk. EVIDENCE: The home has a clear complaints procedure and complaints are promptly addressed. Correspondence relating to each complaint is maintained and shows the progress and outcome. Documentation viewed in relation to one complaint was very comprehensive. The home has contact details for Advocacy Services. Service users are on the electoral role and arrangements are made for postal votes or for service users to attend the polling station, depending on their wishes and abilities. The homes’ policies and procedures for the protection of vulnerable adults (POVA) dovetail with the Local Authority Multi-Agency Adult Protection documentation. Some staff spoken with were unclear regarding the reporting of any concerns of this nature and were also unsure regarding the Whistle Blowing procedure. The Registered Manager said that updates in POVA procedures would be arranged, and staff would be asked to re-read the POVA and Whistle Blowing policies and procedures. St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 14 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 & 26 Overall the standard of décor, maintenance and cleanliness was of good quality, thus providing a pleasant and homely environment for service users. Infection control procedures are followed thus minimising any risk to service users. EVIDENCE: The home is well maintained and appropriate to meet the needs of the service users. Some areas of building works were in progress and appropriate action had been taken to seal off the sections involved from the main building. The central courtyard area was well maintained with splashes of colour in the flowerbeds. A decked area has been created near to the dining room, and this has been fitted with seating, lighting and heating facilities to enable service users and their visitors to sit out in this area whenever they wish. The communal rooms were clean, tidy and homely. Security lighting is in place. Fire drills are now being carried out at required intervals for day and night staff, with clear records kept. St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 15 The laundry room has been relocated and was clean and tidy. It is not in direct contact with service user areas, and the door was open. It was recommended that the door provision be discussed with the London Fire Safety Service to ensure it is appropriate to the use of the room. The washing machine facilities include hot wash and sluice programmes for disinfection purposes. The home has infection control policies and procedures in place. St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 16 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 & 29 The home is appropriately staffed to meet the needs of the service users. Overall the systems for the recruitment of staff were robust and safeguarded service users. EVIDENCE: The home is appropriately staffed to meet the needs of the service users. On the morning shift there are two registered nurses and seven care staff. On the evening shift there are two registered nurses and five care staff. At night there is one registered nurse and four care staff. The Registered Manager keeps the staffing levels under review. Service users spoken with said that staff are caring and that assistance is provided promptly. The staff employment files viewed contained details of the applicants completed application forms, evidence of Criminal Record Bureau checks, medical declaration, 2 references, photographs plus terms & conditions of contract. Two issues regarding a gap in employment details and leave to work in the UK were clarified at the time of inspection. The improvement in the recruitment processes has been maintained. St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 17 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, 35, 36 & 37 The Registered Manager is appropriately qualified and experienced to manage the home. Action has been taken to provide improved systems for the banking of service users funds, assisting in the ongoing safeguarding and management of service users monies. Regular formal and day-to-day supervision for all staff enhance the care provision and the development of staff. Records are held securely thus safeguarding service user information. EVIDENCE: The Registered Manager has BA honours in Healthcare Management, which is appropriate for the NVQ level 4 in management qualification required. He is also undertaking a Masters in Business Administration. The Registered Manager is a first level registered nurse with qualifications in general and mental health nursing. He has over 10 years experience in healthcare and care home management and is responsible for one home. There are clear lines of management and accountability in the home. St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 18 Since the last inspection, a bank account has been opened with named subaccounts for the separate banking of service users monies. Interest is allocated on an individual basis and each service user has separate bank details. For service users with small amounts of money, the residents’ account is still used, with separate records being maintained of all income and expenditure. Individual wallets with a limited amount of cash are kept securely for each service user, so that cash can be accessed for each individual. Receipts for all expenditure are kept in the service users’ personnel files, and some of the records were viewed at random and there was evidence of receipts and clear income and expenditure records being maintained. The Administrator and the Finance and Personnel Manager are appointees for some of the service users admitted before 01/04/02, for whom other appointees are not available. The home has a safe facility. Formal supervision has been introduced for all staff and evidence of this was seen in some departments. Staff are also supervised on a day to day basis, and the care staff spoken with said that they are well supported by the registered nurses. Developmental needs are discussed at supervision and appropriate training can then be accessed to enhance the staff members skills and knowledge. Records are held securely in the home. Aspects of updating for service user plans have been discussed under Standard 7. Otherwise the records viewed to include administration, service users finances and staffing records were up to date. St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 19 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 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 3 x x x 3 3 3 x St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 17 Requirement The service user plan must accurately reflect the condition of the individual and must be kept up to date. Risk assessments must be carried out for all areas of risk and action taken to minimise the risk identified. Assessments to include continence and moving & handling assessments must be completed and kept up to date. Bedrail assessments must clearly identify the appropriateness of the use of bedrails in each individual instance. Appropriate stock levels of medications must be kept in the home to ensure that service users receive their prescribed medication. (previous timescale 05/11/04 not met) All medications must be signed for at the time of administration or the correct endorsement code used. Correct procedures for the recording and signing for all medications to include controlled drugs must be followed. Timescale for action 19/09/05 2. 7 13(4) 19/09/05 3. 8 17 19/09/05 4. 8 13(4) 19/09/05 5. 9 13(2) 12/08/05 6. 9 13(2) 09/08/05 7. 9 13(2) 09/08/05 St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 21 8. 9. 10. 9 9 9 13(2) 13(2) 13(2) 11. 18 13(6) All receipts of medications must be recorded and signed for. Medications must be administered as precribed and accurate stock levels maintained. There must be an ongoing process of audit and review for the management of medications and action taken to address any shortfalls identified. All staff must be clear of the procedures to be followed in the event of any protection of vulnerable adults concerns. They must also be aware of Whistle Blowing procedures. 09/08/05 09/08/05 09/08/05 and ongoing 19/08/05 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 8 8 26 Good Practice Recommendations It is strongly recommended that separate care plan documentation be formulated for each wound identified. It is strongly recommended that all service user plan documentation is signed and dated at the time of completion. It is strongly advised that the laundry door provision be discussed with the Fire Service and appropriate action taken if a shortfall is identified. St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Davids Nursing Home for Disabled Ex-servicemen and Women G61-G10 s10956 Una-St Davids Nursing Home v238841 080805 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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