Inspection on 21/02/06 for St Edmunds

This inspection was carried out on 21st February 2006.

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.

Other inspections for this house

St Edmunds 24/04/07

St Edmunds 26/04/06

St Edmunds 16/08/05

St Edmunds 20/01/05

St Edmunds 20/07/04

St Edmunds 26/03/04

St Edmunds 03/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

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

CARE HOMES FOR OLDER PEOPLE St Edmunds Surrogate Street Attleborough Norfolk NR17 2AW Lead Inspector Mrs Judith Huggins Unannounced Inspection 21st February 2006 1.50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Edmunds Address Surrogate Street Attleborough Norfolk NR17 2AW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01953 452011 01953 457463 terri.mcwilliams@norfolk.gov.uk Norfolk County Council-Community Care Ms Theresa McWilliams Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home can accommodate up to 35 Service Users who are Older People, not falling into any other category. That Service Users who need a wheelchair to assist with independent mobility at point of admission can only be accommodated in rooms 30, 35, 36, 40, 41, 44, 72, 74 and 75. The Home may accommodate one (1) named Service User who is mentally disordered. Maximum not to exceed 35. 11th August 2005 Date of last inspection Brief Description of the Service: St Edmunds Home is situated close to the market town of Attleborough. It is a purpose built home, providing residential care to up to thirty-five elderly people, operated by Norfolk County Council. Accommodation is on two floors and there are bedrooms, sitting and dining rooms on both floors. Access between the floors is by a shaft lift or one of three staircases. The premises were not built to comply with space standards now applicable under the Care Standards Act 2000. This has been partially resolved by a reduction of numbers of service users and the attachment of conditions in relation to rooms occupied by those needing wheelchairs to move independently around their rooms. The home itself is situated by the side of part of the one-way, traffic system around the town centre and there is limited parking on the site. St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and lasted over four and a half hours. Information was gathered from a sample of records, observation, discussion with two care coordinators and three residents, and from attendance at hand over. The manager was not present. What the service does well: What has improved since the last inspection? The management team has worked hard to continue to develop the care plans into a clearer and more organised form (although this work is not yet complete). The frequency with which care is reviewed has improved. The management team have made efforts to increase the frequency of supervision – the content having also improved. There has been some redecoration, including the outside ground floor window ledges – in poor condition at the last inspection, and the WC’s, which had dirty and stained walls. The appearance of these is much improved. An additional member of staff now works on the waking night shift. This helps to address in part, the difficulties experienced by a person with significant confusion, and also contributes to the overall welfare of all residents, the layout of the building and dependency of residents increasing the demands on staff. St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 6 What they could do better: Given the number and nature of repeated requirements and concerns, the providers need to be mindful that enforcement action may be considered. The home continues to offer accommodation and care where documentation of two separate review discussions shows that the service is not able to meet needs. This has an impact upon other residents both in the demands placed on care staff, and from unacceptable and unwanted invasion of their own privacy. There is a “blanket” assessment in use, to determine the risk posed by pressure sores. It is the same for all residents regardless of their nutritional status, skin condition, mobility, general health and weight. It does not therefore reflect a proper assessment of individual need and the care or equipment needed to address this. The process of updating care plan records and documents to adopt a new format needs to continue. Some of the existing records are disorganised, and where they are updated this is not reflected in all the different files which staff need to access. As a result, it is not always easy to see exactly what help or support residents need with care tasks. The providers have looked at this issue during a recent investigation, but without any formal report showing what action they need to take to address the issues the complaint raised. As the providers have responsibility for developing the quality of the service, this information needs to be supplied and acted upon, in the interests of the people living at the home. Additional work is also needed to show that the quality of the service is kept under review and constantly being improved, taking into account the views of residents. There have been requirements made about the standard of the premises in the past. Some of these are still outstanding and have been so for a number of years. Additional requirements have been made as a result of this inspection, including a review of lighting in residents’ rooms, which is not adequate in some cases, for them to be able to pursue chosen hobbies or interests. Staff recruitment is of serious concern. There is a lack of evidence that staff are checked against the register for the protection of vulnerable adults before they start work at the home (and before the full enhanced criminal records St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 7 bureau disclosure is received). Without this evidence, the home cannot fully demonstrate that residents are protected by recruitment practices. Residents also highlight that staff are very busy and stretched and feel that they do not often see the manager. The stated difficulties – being up for approaching three hours before staff can assist with breakfast, being requested to change into nightclothes during the afternoon – means that there are also concerns that staffing levels or deployment do not adequately take into account the dependency and need for physical assistance of all residents. 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 Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 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 the following standard(s): 3 and 6 As at the last inspection, the home is offering accommodation without being able to meet need. Standard 6 is not applicable. EVIDENCE: Accommodation is offered to one person, where records showed at the last inspection the service is not able to meet need. Since then, there has been another review with notes showing again that the service does not consider it is able to meet the needs of the person and a more appropriate placement is needed. Four months after the second review, the person remains at the home. St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Residents’ health, personal and social needs are set out but inconsistencies between documentation mean that needs cannot be demonstrated as fully met. Residents are protected by systems for managing medication – in so far as the standard was inspected. Residents feel that day care staff treat them with respect and uphold privacy, although this is compromised on occasions. EVIDENCE: Staff have been working hard to ensure that there are improvements in the care plan system. However, at present there are several different versions in use. Summaries contained in the daily notes and review file and not always consistent, and do not always match the care plan information set out on individuals’ files. Assessments of risk for individuals who may develop pressure sores are of a standard type recording the same information for each person, and not tailored to the individual (reflecting the individual’s skin condition, mobility, nutritional St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 11 status, diabetes etc). The new plans provide for specific recording of pressure sores and treatment provided, although these are not consistently completed. One person has returned to the home following a hospital admission for a fall. The handover process showed that a physiotherapy referral was considered necessary. The daily notes and care plan do not reflect this and the mobility summary for the same person shows that mobility is considered “good”. There has been an improvement in the frequency of review of care plans, although some of the assessments have not been updated where changes are noted in daily records. The staff member giving medication made the appropriate checks between pack labels and the medication administration record (MAR) charts before administering medication. She took time to explain and encourage residents to take their medication and signed the MAR charts on successful completion. Medication was prepared and administered to one person at a time and the trolley was locked when unattended. Limited numbers of charts were checked and did not present concerns. The care coordinators say that external training is received before staff administer medication. They say that training for night staff remains outstanding and that this has been suggested because they may need to administer “one off” medication to be given when necessary (for example, painkillers). Staff were noted as knocking on people’s doors before entering. Residents say that the staff are very good and confirm that they knock. However, records show that there are occasions when residents’ privacy is compromised by others walking in because they are confused and lost. The providers have made no progress towards meeting previous and repeated requirements (made under this standard and standard 24) for locks to be fitted to bedroom doors. The care coordinators say that this has been discussed recently and they are hoping the work could be completed in the near future. St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15 The range of choice and control residents can exercise is compromised. Residents receive a good diet, although times are not always convenient. EVIDENCE: Residents say they are able to choose what to wear (and that care is taken with the laundering of their personal clothes). They also have a good choice of food. However, they identify staff as being stretched and that sometimes this means it is a long time between them receiving the assistance they need to get up, and being able to be assisted to the dining room for breakfast (from 6.15 to 9am based on discussion). Residents say that it sometimes takes a long time for their suggestions (arising from residents’ meetings) regarding menu changes to be acted upon, and then that the change is not sustained. The inspector was informed of a recent occasion when staff had requested the person be helped into their nightclothes at 4.30pm, the staff member telling the resident there would not be enough staff to help later on during the evening. Another says that it is quite common for people to be assisted into their nightclothes after a bath in the afternoon. St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 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 the following standard(s): 16 There is room for improvement in showing how complaints and concerns are acted upon. EVIDENCE: The inspector is aware of a recent investigation in the home, which raised issues about the care planning process and the way staff understand and work with these. Given issues of care planning noted at this inspection, the findings of the investigation and the action plan arising have an impact on this area of the service. The providers were allocated responsibility for investigating the concerns raised, following a strategy meeting. While some feedback was given over the telephone, there were other issues raised when some more people needed to be spoken to. No further information has been supplied about the action plan to address these concerns. St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 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 the following standard(s): 19, 24 There are some shortcomings in the maintenance of the building for residents. Residents’ bedrooms are not always suitable for their needs and potential safety. EVIDENCE: The service has a history of repeat requirements regarding the maintenance of the premises and a planned programme for achieving compliance has not been provided. However, considerable investment is currently scheduled for the replacement of the lift. The proposed arrangements for ensuring the extensive works do not distress residents were discussed. These may include moving some people temporarily from their rooms, although the distress of this needs to be balanced against any benefits to be obtained and the Commission must be kept informed. (This is a welcome development as the current lift is both noisy and “rough” in operation.) St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 15 The care coordinators also report that restrictors are due to be fitted to ground floor windows – some of these being high and all at risk from intruders (which has happened in the past). Residents feel vulnerable they say, if they open ground floor windows. The requirement has been outstanding for two years. External works have take place to maintain the paintwork. However, one ground floor window in the small front lounge is labelled not to be opened, because the catch is broken. There are residents’ rooms that are poorly lit. One of these visited was discussed with the occupant, who is unable to read or knit because of the lighting arrangements. There is little light reaching the only areas in which the armchair can be positioned, even during the hours of daylight (when the room was visited). There is no accessible socket for an additional lamp. This means that people using the rooms affected are not able to occupy themselves in their own rooms with preferred hobbies, and for those without good eyesight, presents the potential risk of falling where hazards are not clearly illuminated. Not all rooms are able to contain the range of furniture set out in standards. Despite repeated requirements, suitable locks have not yet been fitted so that residents can be given keys unless a risk assessment suggests otherwise. This would help combat intrusions by at least one resident who is documented as wandering into other people’s rooms. St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Residents’ needs are not wholly met by the numbers of staff. There is room for improvement in staff training to show that “safe” and competent members of staff care for residents. Residents are not fully protected by recruitment procedures. EVIDENCE: At the last inspection, serious concerns were identified about staffing levels and the level of vacancies, taking into account the needs of residents. It is apparent that the home has complied with the requirements made about no further admissions and the provision of an additional member of night staff. However, the duty rosters show that 8 shifts were covered by agency staff in the week preceding the inspection, and that there are three part time vacancies. The home continues to provide day care support to up to three people each day and to deal with people with increasing physical and mental frailty. Residents spoken to confirm that staffing levels are not good at times, and that the manager is always busy and does not get much time to speak to them. See also standard 14. Although there are significant numbers of staff currently pursuing NVQ qualifications at level 2 or above, the 50 target is not yet met. St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 17 The files for two recently recruited members of bank staff did not contain any evidence, before they started, of checks against the register for the protection of vulnerable adults. One person had confirmation from the personnel department of the council, that an enhanced Criminal Records Bureau (CRB) disclosure had been received and was acceptable, but this was dated after the person started their employment. The second person had no confirmation of CRB receipt and without confirmation of the CRB having been obtained, cannot be employed further at the home. There was no evidence that staff had been supervised at all times by a named and appropriately checked colleague, pending receipt of the full CRB disclosure. Staff files did not contain evidence of appropriate completion of induction/foundation training matching the approved standards. St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 Residents live in a home that is appropriately managed. There is room for improvement in showing that the home is run in the best interests of service users. Residents’ financial interests are protected. Staff are not yet appropriately supervised. EVIDENCE: The manager is registered with the Commission and has received management training. She has effected some much needed change since starting work at the home. Evidence of qualifications and continued training updates was not verified in her absence. St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 19 Residents spoken to say that the manager is very busy and that they do not see much of her on a day-to-day basis. However, they say they are able to express their views to other staff on shift, and also at residents’ meetings, which are held regularly. They also commented that it sometimes took a long time to act upon their suggestions (see standard regarding nutrition and food). Visits on behalf of the registered provider were being made, but there is some slippage in the frequency (or a failure to supply reports every month to the Commission). Additionally, no information regarding an improvement plan arising from the organisation’s own quality monitoring purposes has been supplied to the Commission. There are detailed financial records for persons whose personal allowances are retained for safekeeping, showing monies received and spent, with numbered and corresponding receipts. There is also confirmation in the finance file, of the people for whom the local authority acts as appointee. Unlike a previous inspection, no occasions were identified on records sampled, where residents had a “negative” balance recorded, effectively meaning that they were (unacceptably) borrowing from one another. A selection of supervision records was checked, for one new member of staff and three others supervised by the Care Coordinators. These show that efforts have been made to improve the process and several staff received supervision in January. One new member of relief staff had been supervised. However, staff are not supervised with the frequency set out in standards (two people only three times in 12 months, and one only 4). The care coordinators say that they receive supervision themselves from the manager about once every two months, although this was not checked in her absence. Standard 38 was not inspected, although no confirmation has been received by the Commission that the works needed to comply with the fire risk assessment were completed by the date submitted with the Action Plan following the last inspection. The requirement has been repeated with adjustments to reflect this. St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 x 2 X X X X 2 x x STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 2 x x St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement The registered persons must make alternative arrangements and not continue to offer accommodation where it is identified the service is unable to meet need. The registered persons must ensure that summaries of care needs set out in care plans, daily note files, and review files, are consistent so that staff are aware of the current support needs of each resident. The registered persons must ensure that assessments of risk or need are specific to the need of each individual resident – particularly in relation to pressure sores - and document the actions necessary to reduce the risk to each individual. Outstanding requirement The registered persons must submit a programme with timescales for fitting appropriate locks to all bedrooms doors, prioritising residents whose risk assessment and consultation process shows their desire and ability to hold keys. All residents DS0000035075.V284030.R01.S.doc Timescale for action 31/03/06 2 OP7 12, 15 30/04/06 3 OP8 14, 13(4) and (6) 31/03/06 4 OP10 12 and 13(4) 30/04/06 St Edmunds Version 5.1 Page 22 5 OP16 22 6 OP19 12, 7 OP19 37 8 OP19 23 9 OP24 23, 10 OP10 and OP24 12, must be offered keys subject to risk assessment. UNMET SINCE 2002. The registered persons must supply the Commission with a summary of complaints over the last twelve months, together with the action taken or needed to address them. 13, 23 Outstanding requirement The registered persons must ensure that action is taken to prevent intruders from entering the building via ground floor windows. (This will also help to address current and documented risks.) UNMET FOR ALMOST TWO YEARS The registered persons must inform the Commission of events affecting the welfare of residents (specifically, arrangements and risk assessments for individuals affected by the lift replacement and unable to use the temporary chairlift). The registered persons must replace/repair the window catch (or – if not possible, replace the window) to the small front lounge. 13(4) The registered persons must review lighting arrangements in residents’ rooms to ensure that the lighting is adequate for safety and for residents to engage in preferred activities. 13(4) Outstanding requirement The registered persons must fit appropriate locks to all bedrooms doors, prioritising residents whose risk assessment and consultation process shows their desire and ability to hold keys. All residents must be offered keys subject to risk assessment. (Outstanding for more than two years.) DS0000035075.V284030.R01.S.doc 31/03/06 30/04/06 14/03/06 30/04/06 31/03/06 30/04/06 St Edmunds Version 5.1 Page 23 11 OP14 and OP27 10, 12, 13, 18 12 OP29 18 13 OP29 18 14 OP33 24 15 OP33 26 16 OP36 18(2) 17 OP38 10, 13, 23(4) Outstanding requirement The registered persons must ensure that staffing levels are adequate at all times to revised to reach or exceed the minimum required based on the assessment of dependency and need. This must include additional provision to address the needs of those receiving day care. The registered persons must not on any account employ staff to work at the home until a POVA First check has been confirmed as clear (and all other required information in statutory records has been obtained with the exception of the full CRB). Refer to Schedule 2 of regulations as revised in 2004. The registered persons must ensure that staff with proof of identity, references and POVA disclosures are supervised by named members of staff until the full CRB is received – as set out in Department of Health guidance. The registered persons must supply reports arising from the periodic review of service quality (including the views of residents) to the Commission. The registered persons must ensure visits are carried out on behalf of the registered providers, with the frequency set out in regulations, and with reports supplied to the Commission. The registered persons must ensure that staff are supervised with the nature and frequency set out in standards. The registered persons must provide evidence that the works identified as necessary by the DS0000035075.V284030.R01.S.doc 30/04/06 14/03/06 14/03/06 30/04/06 31/03/06 30/04/06 31/03/06 St Edmunds Version 5.1 Page 24 fire risk assessment have been completed. 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 Refer to Standard OP7 OP9 Good Practice Recommendations The registered persons should ensure that all care plans are updated using the “new” format, which provides for clearer and fuller recording. The registered persons should ensure that night staff receive training in the safe administration of medicines so that residents who need particular treatment, such as painkillers, are not denied this promptly. The registered persons should review practices for assisting residents into their nightclothes several hours before bedtime, as this compromises their dignity. The registered persons should explore how the manager can make herself more accessible and available to residents. 3 4 OP14 OP33 St Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Edmunds DS0000035075.V284030.R01.S.doc Version 5.1 Page 26 - 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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