Inspection on 05/07/05 for St Leonards

This inspection was carried out on 5th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Leonards 15/05/08

St Leonards 15/05/07

St Leonards 19/06/06

St Leonards 12/01/06

St Leonards 04/01/05

St Leonards 30/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE St Leonards 86 Wendover Road Aylesbury Bucks HP21 9NJ Lead Inspector Joan Browne Unannounced 5th July 2005 12:15pm 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 Leonards Version 1.10 Page 3 SERVICE INFORMATION Name of service St Leonards Address 86 Wendover Road, Aylesbury, Bucks, HP21 9NJ 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) 01296 337765 01296 339529 Colley Care Limited (Trading as B & M Care) Care Home 45 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (22) of places St Leonards Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2005 Brief Description of the Service: St. Leonards is a purpose built care home providing personal care and accommodation for 45 older people who are elderly frail and elderly mentally infirm. It is divided into two units. One unit caters for older people with physical frailties, the other for older people with mental frailties. It is owned by B & M Care Limited, which is a private care organisation. The home is located on the outskirts of Aylesbury town, close to shops, pubs, the post office and other amenities. Public transport is easily accessible. The home was registered on the 19th April 2000 and consists of two floors. All bedrooms are single with en suite facilities. There is a passenger lift. The home has a landscaped garden to the rear that is accessible to the residents. St Leonards Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home, which took place on the 5th July 2005 from 12.15 pm to 18.30 pm. The lead inspector was Ms Joan Browne who was accompanied by Mrs Gill Wooldridge (Inspector). The inspection consisted of meeting with residents, relatives, staff, examination of care documentation and records. Relatives spoken to were complimentary about the provision of care. Comments made were as follows: “Staff are caring”, “staff are very kind”, “the food is good,” “the staff make me feel welcome”, “the home is like a four star hotel”. A tour of the communal areas, general kitchen and some bedrooms was carried out. The serving of lunch was observed on the dementia unit. The inspectors fed back to the manager and project manager the out-come of the findings of the inspection. What the service does well: What has improved since the last inspection? Recent work on the environment and the dementia unit has resulted in the home now being truly domestic in character. The residents seem more settled St Leonards Version 1.10 Page 6 as a consequence, particularly at mealtimes. The home now has a sensory garden. More trips outside the home are arranged. The home has developed a support group known as ‘Friends of St. Leonards’. The home has employed a chef and an assistant chef. Work is in progress to review the daily food menus and to developing a new care plan format. Student nurses are now seconded in the home to do work placements. Walking handovers are now conducted on every shift. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Leonards Version 1.10 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 Leonards Version 1.10 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) None of these standards were assessed at this inspection. EVIDENCE: St Leonards Version 1.10 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 To ensure that residents’ health personal and social care needs are fully met care plans need to include more detailed information. Current medication practice does not conform to good practice guidelines as outlined by the Royal Pharmaceutical Society. This has the potential to affect residents’ safety. EVIDENCE: It was noted that a new care plan format was in the process of being developed. The plans covered the following headings: Bathing, personal care, dressing, communication, continence, mobilising, risk of falls, eating and drinking, awareness of surroundings, social activities, medication, activities of daily living, sleeping, medical condition and unmet needs. The new format appeared more concise and easy to follow. Three residents’ care plans were examined and it was noted that one particular resident’s plan had been updated to the new format. The information recorded on personal care was detailed. However, more detailed information in the action plan is required to guide staff on how needs should be met fully. The preferred time of rising and retiring was clearly outlined. It was noted that a behavioural chart had been developed for the individual but staff were not consistent in recording daily St Leonards Version 1.10 Page 10 entries. The particular resident had sustained two falls however, the moving and handling risk assessment was not reviewed. It was noted that the daily report writing did not describe staffs’ good practice. The following information was recorded in a particular resident’s daily record sheet- ‘X slept well all night no problems. She was found in the floor when the morning shift started. Senior and deputy manager informed.’ The information written in the daily report failed to mention the frequency of checks carried out and what reassurance was offered to the individual. It was noted that plans were not being reviewed monthly. Inspectors were told that some relatives were involved in the review of care plans. It was noted that ‘tippex’ correcting fluid was used to correct errors recorded in care plans. This practice should cease. A requirement is being made for all staff to undergo further training in care planning and report writing. It was noted that individual protocols were not in place for residents who were having treatment for diabetes and catheter care. As a good practice individual protocols should be developed incorporating staffs’ good practice. The home uses the Boots Manrex monitored dosage system. It was noted that the pharmacist carried out a recent medication audit. A copy of the audit report was available for inspection purposes. The medication administration record sheets (MARS) were examined and gaps were noted on some sheets. Blister packs were checked and it was noted that in some instances medication was administered but was not signed for. Eye drops in use did not record the dates they were opened. It was noted that entries had been scribbled over and hand written entries recorded on MAR sheets were not signed and dated by two staff members. As a good practice it is recommended that handwritten entries recorded on MAR sheet should be checked, dated and signed by two staff members. Entries recorded in error should have a line drawn through with an explanation written. For example, entered in error. When medication has been stopped by the general practitioner (GP) or antibiotic treatment discontinued, as a good practice the person making the entry should record a brief explanation. For example, stopped by the GP, course completed. The entry should be signed and dated. The controlled drug register was checked. It was noted that there were some incomplete entries recorded in the register for Temazepam medication by staff members. However, the tablets in packets corresponded with balances in the register. It was noted that a particular resident who was prescribed Paracetamol tablets had run out of stock. The individual’s MAR sheet stated that tablets were in stock from the 29th June. However, staff continued to use the F code to denote that tablets were not available. It was stated by staff that regular monitoring of medication was taking place. However, there was no evidence available to substantiate that monitoring was taking place. Senior staff spoken to confirmed that they had had their competencies in the administration of medication assessed. St Leonards Version 1.10 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) 12 & 15 An activities programme is in place which aims to meet the social and recreational expectations of residents. To ensure that residents have a wholesome meal menus need to be nutritionally balanced. The arrangement in place for the disposal of waste food was institutionalised and spoiled the ambience of the mealtime. EVIDENCE: St Leonards Version 1.10 Page 12 Overall those residents spoken with who were able to articulate their views and confirmed that the lifestyle experienced in the home matched their expectations and preferences. However, one resident who was recently admitted to the home stated that she would like to be more involved in participating in daily activities to maintain her independence and was finding it difficult adjusting to having things done for her. The home employs an activity organiser. The weekly activity programme was displayed on the wall. The programme appeared varied and there was the opportunity for residents to have one to one time and to be taken out in the home’s car for trips. Unfortunately the inspectors were unable to discuss the programme in detail as the activity organiser was away on leave. However, inspectors were told that in her absence staff implement the programme but this was not evident on the day of the inspection. Lunch was observed on the dementia unit. The choices on offer were macaroni cheese, new potatoes and peas. Dessert was bread and butter pudding with custard. Lunch appeared a bit high in carbohydrate content. Cranberry and orange juice was on offer. Staff confirmed that residents were offered an alternative choice if they did not like what was on offer. It is recommended that the manager should ensure that choices in the daily menu are nutritionally balanced and wholesome. The dining room area had been developed to provide a relaxed, warm and welcoming atmosphere with relaxing music available. The tables were attractively covered with tablecloths, napkins, condiments, and appropriate cutlery and crockery were provided. Carers assisted residents who needed assistance with feeding in a sensitive and discrete manner. However, The inspectors were disappointed to note that the practice of disposing of waste food in a plastic container in the dining room was still in place. It is recommended that staff review the practice of the disposal of waste food at meal times. Inspectors were told that additional staffing was available to assist residents with feeding at lunchtime however, this was not evident on the day of the inspection. St Leonards Version 1.10 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 & 18 The apparent openness of staff along with a clear complaints policy should ensure that any concerns raised are actioned. Staff have undertaken training in adult protection and abuse awareness. With clear guidelines this should ensure that residents are protected from any potential abuse. EVIDENCE: The home has a complaints policy in place. Residents and relatives are made aware of the policy and are able to comment about the service delivery. Inspectors were told that there had not been any recent complaints made to the home. However, the Commission had received two anonymous complaints and they were brought to the manager’s attention. The home has satisfactorily investigated an adult protection issue recently that resulted in members of staff being dismissed. A referral has been made to the Department of Health for the staff members to be placed on the Protection of Vulnerable adults (POVA) register. Inspectors were told that all staff have undertaken adult protection training and the revised Buckinghamshire County Council adult protection policy had been incorporated into the home’s adult protection policy. St Leonards Version 1.10 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, 20, 21, 22, 24, 25 & 26 To ensure that residents live in a safe environment the building is maintained and appears to comply with the standards of the fire safety services. Communal areas in the home were welcoming, comfortable and provided the residents with an attractive social environment. To ensure that residents’ privacy and dignity are not compromised personal care items need to be stored discretely. Residents’ bedrooms appeared well furnished and homely. However, floor coverings in three bedrooms posed and health and safety problem to residents occupying them. Pedal bins are needed to help prevent the spread of cross infection which could potentially put residents health at risk. St Leonards Version 1.10 Page 15 EVIDENCE: The location and layout of the home appears suitable for its purpose it is accessible, safe, well maintained and meets service users’ needs. The grounds and garden were well maintained. The home has complied with requirements made from the fire safety officer’s visit. There was no record available to confirm that an Environmental Health Department officer had recently visited the home. The building does not have CCTV cameras installed. The home has three lounges and two dining areas, which meet the current National Minimum Standards. The garden is secure and accessible to wheelchair users. Lighting in the communal rooms was adequate and domestic in character. Furnishings were of good quality and domestic in character. The home has adequate numbers of toilet and bathroom facilities, which are situated near the lounges and dining areas and are clearly marked. Residents have access to all parts of the communal and private areas via the passenger lift and stairs. Handrails are provided in corridors, grab rails in toilets and bathrooms. Mobile hoists are provided to assist with moving and handling. Call bells are provided in bathrooms, toilets, communal areas and service users’ bedrooms. Residents’ bedrooms were comfortable with appropriate furnishings. Some bedrooms were personalised with personal items of furniture, family pictures and mementoes, which reflected the individual characters of residents. It was noted that three bedrooms had a strong odour. The inspectors were told that carpets are cleaned regularly. A requirement is being made for floor coverings in these bedrooms to be replaced. The wallpaper in bedroom 8 was lifting and required attention. The manager reassured the lead inspector that it would be seen to. It is recommended that the manager carry out a maintenance audit of the building on a regular basis. The heating, lighting, and ventilation in residents’ bedrooms appeared to meet the relevant environmental health and safety requirements. Rooms were centrally heated, radiators were covered and the lighting meets the current recognised standards. Emergency lighting is provided throughout the home and weekly checks are undertaken and recorded to ensure safety. This is deemed as good practice. Restrictor valves were fitted to hot water taps in residents’ bedrooms and toilet and bathing facilities. Staff record temperatures when assisting residents with bathing. St Leonards Version 1.10 Page 16 On the day of the inspection the home was bright, clean, hygienic and free from odours in communal areas. The laundry room is situated away from where food is prepared and stored. It was noted that the ceiling lights contained dead insects and required cleaning. The washing machines have the specified programming ability to meet disinfection standards. The inspectors were told that soiled linen is washed separately to prevent the spread of cross infection. It was noted that general waste bins in areas of the building was of the swing top type. It is required that these are replaced with foot pedal bins to prevent the spread of cross infection. St Leonards Version 1.10 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 & 30 The home’s recruitment procedure needs to be robust to protect residents from possible abuse. To ensure that residents’ needs are fully met planned training needs to be programme and take place. EVIDENCE: The inspectors examined staff records for the three most recently appointed staff members. Completed application forms were in place. Two written references were obtained. However, in one particular staff member’s record the employment history was not explored and the individual commenced employment without the clearance of a POVA first check and a Criminal Record Bureau (CRB) check. It was also noted that references obtained for one individual was not from the most recent employer. The manager is required to ensure that references obtained must be from a recent employer relating to the person’s last period of employment of not less than three months duration that involved work with vulnerable adults. Where a person has previously worked in a position that involved contact with vulnerable adults, written verification so far as reasonably practicable of the reason why he or she ceased to work in that position should be obtained. St Leonards Version 1.10 Page 18 It was noted that the practice of leaving senior staff that have not undertaken first-aid training in charge of the building is continuing. This practice is not acceptable and must cease. The inspectors were told that arrangements were being made for staff to undertake training. At the last inspection a requirement was made for the manager in the interim period to assess staffs’ competences in dealing with a first-aid emergency and to keep records for inspection purposes. However, records of assessments carried out were not available during the inspection. The manager is required to forward to the Commission copies of individual members of staff assessment records. The training records for two recently appointed members of staff were examined. Evidence was available to substantiate that staff had undertaken induction training. However, there was no evidence available to confirm that mandatory training for other staff members were being updated. The manager is required to develop a training matrix listing staff names with mandatory training undertaken. This should be made available for inspection purposes. St Leonards Version 1.10 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 &38 A supervision framework needs to be in place to ensure that residents’ wellbeing, health and safety are protected. To ensure residents’ health and safety is not compromised records relating to food handling and health and safety need to be maintained. EVIDENCE: St Leonards Version 1.10 Page 20 The home does not appear to have a structured supervision framework in place. Staff are not receiving one to one supervision on a regular basis. This remains an outstanding requirement. The manager is required to ensure that staff are given regular supervision. It was noted that daily food and refrigerator temperatures were not being recorded. Opened bottles of sauces were not labelled, dated and refrigerated. The cooker filters and ceiling lights required cleaning. The refrigerator in the satellite kitchen required cleaning and opened packets of biscuits were not placed in airtight containers. The fire records were examined and it was noted that weekly checks of the fire panel and the emergency lighting are carried out. The service records for fire extinguishers were up to date. The inspector noted that latex gloves and pads were visible in one bathroom. Staff are reminded of their responsibility to lock gloves and pads in the cupboards provided after use. It was also noted that there was a bottle of shower gel and soap in the bathroom, which made it look like toiletries were being shared. Staff are reminded of their duty to ensure that residents’ toiletries are returned to their bedrooms after use. It was noted that to date not all staff have undertaken first aid training including senior staff who are left in charge of the home. The inspectors were told that those staff who have not undertaken first-aid training have their competences regularly assessed. However, records of assessments undertaken were not available at the time of the inspection. A further requirement is being made for all staff to undergo first-aid training. The accident book was examined and it was noted that some entries recorded lacked detailed information. For example, details of how the accident occurred and injury sustained and treatment given were not recorded. It is required that a system is developed to audit accidents sustained by residents to detect if there is a pattern to falls. When necessary residents’ moving and handling assessments should be updated. St Leonards Version 1.10 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 x 2 2 2 STAFFING Standard No Score 27 x 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 2 x 2 St Leonards Version 1.10 Page 22 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. 2. Standard 7 8 Regulation 18(1)( c ) (i) 13(2) Requirement The manager must ensure that staff undergo further training in care planning and report writing. The manager must ensure that staff record, administer and store medication in accordance with the Royal Pharmaceutical Society guidelines. (Previous timescale of 31.03.05 not met) The manager must ensure that MAR sheets are audited on a regular basis. Evidence of audits undertaken must be kept for inspection purposes. The manager must ensure that room carpets identified during the inspection as requiring replacement must be replaced. The manager must ensure that ceiling lights in the laundry room are cleaned. The manager must ensure that swing top waste bins are replaced with foot pedal bins to prevent the spread of cross infection. The manager must ensure that staff recruitment conforms with Regulation The manager must develop a structured supervision Version 1.10 Timescale for action 05.07.05 and ongoing 31.03.05 3. 9 13(2) 30.08.05 4. 24 23(2)(d) 20.08.05 5. 6. 26 26 23(2)(d) 16(2)(k) 05.07.05 and ongoing 30.08.05 7. 8. 29 36 (9) (c ) (i) 18(2) 05.07.05 and ongoing 04.01.05 and Page 23 St Leonards 9. 38 16(2)(h) 10. 38 23(2)(l) 11. 38 18(1) (c ) (i) framework to ensure that all staff receive six supervision sessions yearly. (Previous timescale of 04.01.05 not met). The manager must ensure that opened bottles of sauces are refrigerated, labelled and dated. Opened packets of biscuits must be kept in airtight containers. The manager must ensure that latex gloves and pads are stored in cupboards provided out of view. Residents toiletries must not be left in bathrooms. The manager must ensure that all staff undergo training in firstaid. In the interim copies of assessments undertaken by staff in the treatment of first-aid must be forwarded to the Commission ongoing 05.07.05 and ongoing 05.07.05 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. 4. 5. Refer to Standard 7 8 9 9 9 Good Practice Recommendations It is recommended that the manager should ensure that tippex correcting fluid is not used on care plans. It is recommended that the manager should develop individual protocols for residents who are having treatments for diabetes and catheter care. It is recommended that the manager should ensure that handwritten entries recorded on MAR sheets are checked, signed and dated by two staff members. It is recommended that the manager should ensure that eye drops are dated when opened. It is recommended that the manager should ensure that when medication is stopped or antibiotic treatment completed the entry should be dated and signed by the staff member recording the entry. It is recommended that the manager should review the practice of food disposal at mealtimes. It is recommended that the manager should ensure that choices on the food menu are nutrionally balanced. Version 1.10 Page 24 6. 7. 15 15 St Leonards 8. 9. 24 38 It is recommended that the manager should carry out a monthly maintenance audit. It is recommended that the manager should audit the entries recorded in the accident book. Accidents should be monitored to detect if there is a pattern to falls sustained by residents. St Leonards Version 1.10 Page 25 Commission for Social Care Inspection Cambridge House, Smeaton Close 8 Bell Business Park, Aylesbury Buckinghamshire HP19 8JR 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 Leonards Version 1.10 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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