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

This inspection was carried out on 3rd March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Marys Nursing Home 15/04/08

St Marys Nursing Home 09/08/07

St Marys Nursing Home 05/06/06

St Marys Nursing Home 10/11/05

St Marys Nursing Home 18/04/05

St Marys Nursing Home 26/10/04

St Marys Nursing Home 26/05/04

St Marys Nursing Home 07/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Marys Nursing Home 327 Main Rd Sidcup London DA14 6QG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rosemary Blenkinsopp     Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: St Marys Nursing Home 327 Main Rd Sidcup London DA14 6QG 02083027289 02084607393 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : St Mary`s Care Home Ltd care home 20 Number of places (if applicable): Under 65 Over 65 20 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home St Marys Nursing Home is registered with the Commission for Social Care Inspection to provide nursing care for 20 Older People. The home is situated on a main road in a residential area of Sidcup close to local shops and bus routes. The detached two-storey house was not purpose built. It has five double and one single bedroom on the ground floor and nine single bedrooms on the first floor. One of the bedrooms has en suite facilities the remainder have washbasins with hot and cold water. Communal areas include a lounge, separate dining room, kitchen and laundry area. Care Homes for Older People Page 4 of 29 Brief description of the care home Adequate bathing, toilet and sluicing facilities are provided. At the rear of the building there is a garden for residents. use, which is wheelchair accessible. Visitors can park on the front drive or in the side roads. The current fees ranged from £572.00 - £600.00. Residents paid privately for personal items, hairdressing and chiropody services. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The manager facilitated the site visit. Periods of observation were undertaken on the site visit. Prior to the inspection the manager had completed the AQAA and forwarded this to the CSCI. Comment cards were sent to the service and provided during the site visit. During the visit the inspector met with several residents. Many comment cards were returned although not until after the site visit. Staff were interviewed as part of the site visit. Several residents were in the home during the site visit and spoke to us. Care Homes for Older People Page 6 of 29 All of the information obtained from the sources identified above has been incorporated into this report. A selection of documents were inspected including care plans, complaints information as well as health and safety records. Feedback was provided to the manager at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. The reports from the homes own systems for self monitoring and audit, were also considered when compiling this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were admitted based on an assessment of need and the service confirms that they are able to meet their needs. The pre-admissions procedures provide staff or residents with the information they require to ensure they can meet residents needs. Evidence: The home produces a Statement of Purpose and Service User Guide which is available and sent to prospective residents. Assessment procedures included St Marys own assessment the content of which was satisfactory. Additional information included A & E documentation , Doctors letters and the Community Care Assessment from the funding authority, all of which provided staff with good information on which to base the care and form a basis for an initial care plan. Care Homes for Older People Page 10 of 29 Evidence: There was evidence in some of this assessment material that residents had included in their information a diagnosis of Dementia as well as other physical health problems. It was not obvious if this was the primary diagnosis or as part of other health issues. The home is not registered for the Dementia category and must only seek to admit those for whom it is registered namely older persons. If there is a diagnosis of Dementia the home must be satisfied that it can meet all the residents needs. Residents were asked about trail visits and care plan input those spoke to were unaware of what the inspector was referring to. The manager stated that trial visits were offered but in reality many are too frail to undertake these, however relatives do visit prior to admission. The home provides written confirmation that it can meet the residents needs following their own assessment. Care plans included assessment information. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place for each resident. These provide staff with information on the physical health needs of the resident although little on other aspects of care. Risk assessments are in place and kept under review. The medications are safely stored and administered correctly. The supporting records were not as well maintained and introduced a margin for error. More attention to detail in respect of documentation is required , to ensure all procedures are safe. Evidence: Sixteen residents were on site during the visit there were four vacancies. One qualified nurse and three care staff were on duty and the manager arrived during the course of the morning. We were advised that no residents had MRSA and two had hospital acquired pressure sores. Staff were asked questions relating to pressure area treatment as this had been raised as a concern September 2008. The staff interviewed demonstrated sufficient Care Homes for Older People Page 12 of 29 Evidence: knowledge of how to action such and refer on to specialist teams. Care plans were selected for viewing. The records included risk assessments for manual handling, nutrition, falls, skin integrity as well as monthly observation checks. Care plans in the main reflected only the physical issues of care, social and psychological issues were less well addressed. One resident was suffering dementia and depression as indicated in her assessment material, yet neither of these featured in her care plan. The interventions, which details the actions staff are to take to address the issues,were reasonably well completed and would provide staff with a framework on which to give care. In one evaluation there was reference to this resident expressing the wish to die yet it appeared no action had been taken to address this information,which was included in a review dated 5/12/08, hence there had been time to refer this on to the GP or a suitably qualified professional for advice. The manager said this had been discussed with family members although there was no documentation regarding this discussion. Evidence of referral to other professional services such as optician, podiatry etc were in the files sampled. One health professional commented the home is safe, a medical model institutional with no imagination used. There was a placement review conducted by the funding authority. There were food monitoring charts in place for one resident, as it was deemed she required close monitoring due to her weight. On several days there were no entries recorded and entries in relation to food and fluid were omitted. Some of the care interventions seemed to be routine and task driven for example fluids given out at a set time. The qualified nurse was doing the medications as we arrived. The practice was safe Afterwords the records were checked for accuracy. There was a list of staff signatures of those who administer medications in addition the UKCC guidelines were available. On several of the medication charts the allergies section was not completed. Those residents who required creams to be administered had their charts ticked to indicate this. Some gaps were apparent in the records. One chart was very untidy and this may introduce a margin for error. There were other charts which had red and black pen used on them. Red pen was used to make amendments to the instructions for the medication , this had been done by the Care Homes for Older People Page 13 of 29 Evidence: manager. The changes mainly referred to administering medication as required, as opposed to regularly. The instructions on the charts are as per the GP, and his written directions should be followed, unless advice to the contrary is received. In the event that the GP alters the directions this should be clearly recorded and the amendment made so that the chart is not defaced and legible. The manager said that she had consulted with the GP on the amendments. Medications which are to be given as required need full instructions on the maximum dose, reason for administration and where applicable the duration for the medication to be given. Medications are stored in a Bristol Maid drug trolley, there is one for the home located on the first floor, which is securely attached to a wall. There is a small clinical room on the first floor, this room is for medications to be stored it also contains a fridge. It is essential that the room is kept at the correct temperature in order that the medications do not deteriorate. Temperatures for this room were recorded, as it is prone to become overheated. One bottle of eye drops, which was in use, was not dated on opening. It is important that dates on opening are recorded as once opened they have a short shelf life usually of 28 days. Equipment was being used for those residents who required it including walking aids and pressure relieving mattresses. Hoists were available including one to the bath. Residents who were in bed had call bells close at hand. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Contact with friends and family is promoted with open visiting and events which families are invited to. Residents have some activities provided although these in the main are passive with little evidence that residents had choices in their day. Evidence: During the site visit there were many relatives in visiting, several of whom we spoke to. Favourable comments in respect of the staff working in the home were received staff are very good - they look after people it was the first place we visited . Another relative was taking her mother out for her 90th celebration she also related favourable comments regarding the care her mother received. The TV was playing throughout the morning - the same channel. Staff did not seek to obtain residents views on whether they wanted the TV on, or which channel they preferred to watch. Some residents had their eyes closed -evidently asleep. Two ladies were positioned at right angles to the TV, to actually watch the TV they would have had to turn at an angle even if they did do this, then one would still not be able to view the TV . Care Homes for Older People Page 15 of 29 Evidence: In the dining room which was not in use, the calenders were still showing January 2009, and in some bedrooms visited this was also the case. Whilst this may seem a trivial thing residents in care homes can quickly become disorientated therefore all measures to keep orientation aids up to date should be in place. The manager advised that although the dining room was not used on the day of the site visit it is in frequent use at other times. Fluids were brought in mid morning, prior to this some residents had cold drinks, others were without a drink. We were unclear what time breakfast had been given so it was unclear what the duration was between drinks. Staff advised us it had been between 8am and 9 am. It is particularly important that elderly people are kept well hydrated as they can dehydrate quickly especially in warm weather. The lunch menu offered two hot choices. The lunch was served either in the lounge area or the residents own bedroom, the dining room was not used . We were advised residents did not want to move to the dining room for their meal. Three residents continued to be sleepy and perhaps would have benefited from an afternoon nap. There was no engagement between residents and staff except when this was task orientated i.e giving drinks or assisting to feed. Interaction between staff and residents was in the main task focused and doing for them, with little evidence of enabling independence or promotion of choice. In the kitchen, new equipment which had been purchased, was in use. In the fridge there were a number of yogurt /fromaige frais which were out of date and needed to be removed. At 10 20 am there were two plates of sandwiches made up for that evening . The sandwiches were mixed filings and covered however this is a considerable length of time prior to the serving of them. The swing bin lid in the kitchen was missing and if food were being disposed in this, it would attract flies, and the windows were without fly screens. This could cause a health hazard and adversely affect residents and needs to be actioned. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies, procedures and records were in place in relation to management of complaints and safeguarding adults. Residents and relatives indicated they knew who to talk to if they had a concern. Staff demonstrated limitations in dealing with issues of safeguarding therefore this may compromise residents safety . Evidence: The complaints information was on display as was the Charter of Rights. Time frames for responses were included in this information and reference to external organisations to contact if they remain dissatisfied. No complaints have been received through the CSCI, although there was one safeguarding issue which was dealt with through the Care Management Team, September 08. The home to date have not been advised of what the outcomes of the investigation have been ,nor have they been contacted directly to ask for their input into the investigation. The staff were asked about whistle blowing and dealing with abuse . Those spoken to had limited knowledge on the topics and in one case the staff member was very Care Homes for Older People Page 17 of 29 Evidence: confused about the two topics. In addition staff were vague about where to report suspected abuse particularly the external contacts. One staff was unfamiliar with the term whistle blowing and did not have a knowledge in the area or how to action it. The manager was clear that training had been provided on this topic to all staff . She stated that she would re visit the training with the staff to ensure that they were knowledgeable and competent in the field. The knowledge and ability that they demonstrated would not ensure residents safety, and it was lacking in some of the basic areas. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides satisfactory accommodation for residents to live in with sufficient communal space and equipment to address their needs. Evidence: The home is located close to Sidcup on a main road. It is easily accessible by bus and car parking is available to the front of the building. The exterior of the home was satisfactorily maintained. A tour of some of the bedrooms and communal areas was undertaken. On entering the home there was an odour in the hallway and lounge and a smell of bleach when staff were asked about this staff were unable to state where it was coming from. The home has a passenger lift to access the other floors. The bedrooms are different sizes. Bedrooms seen in the main were clean tidy and had items making them look personalised and individual. There was evidence of upgrading in some areas that included new carpets and redecoration. In the lounge some of the chairs that residents were sitting in were worn. It was Care Homes for Older People Page 19 of 29 Evidence: unclear if the residents seating needs had been taken into account, and when new chairs are purchased this should be considered with various styles and shapes for individual needs. Foot stools were available and in position so residents could rest their legs. All seating should be maintained in a good state of repair and individual to meet residents needs New kitchen equipment had also been purchased and was in use. The kitchen was tidy and organised. Sluice facilities were provided and staff had access to protective clothing and hand washing facilities. The rear garden was neat and tidy and accessible to wheelchair users. The exterior of the home was satisfactorily maintained. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Records showed adequate staffing levels were maintained. Staff felt they were sufficiently trained to do the work they do and training records confirmed this. Staff recruitment procedures ensure staff are safe to work in the home. Evidence: Several staff were interviewed as part of the site visit including the qualified nurse on duty and care staff. The cook was spoken to briefly. The nurse in charge was a bank staff and she was interviewed. Her induction was over a one day period with an additional 3/4 days orientation when she started. In addition she said that she has regular updates in the mandatory topics some through her full time employer. Another staff confirmed that she had completed her NVQ level 2 and was proposing to do NVQ level 3. She said that she had done updates in the mandatory topics in the last year including fire, health and safety. Care Homes for Older People Page 21 of 29 Evidence: We viewed the files of three members of staff, two of whom were new employees. The personnel files relating to the two new employees contained the information required by the Regulations including application form, interview schedule, proof of identity, medical questionnaire, Criminal Records Bureau (CRB) check and two references. We made the manager aware that one of the references was from an employer not detailed on the application form and that there is a need to verify previous employment in care. The off duty rota indicated that the qualified staff did long days and the manager was indicated as covering some of the morning duties. Staff felt that they had enough staff to cope with the workload and during the site visit this seemed satisfactory with care addressed promptly and call bells answered. No concerns were raised regarding staffing levels or the care that they provided, in fact several compliments relating to the staff were received. The home retains a stable staff team many have been in post several years, this provides consistency in care which is beneficial for residents. Supervision records were retained hes were short simply outlining the points of discussion,although little detail was included. Staff said that they received regular 1 : 1 supervision and could approach the manager at any time. Attendance certificates of the training attended were retained. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a suitably qualified and experienced person. Health and Safety issues are addressed to ensure the home is safe for people to live in. Quality assurance measures and an annual review of the service need to be further developed to ensure that the views of persons living in the home are sought and taken in to account. Evidence: On entering the home the lift engineers were attending to the lift. They confirmed that they were on a 24 hour call out for this. Service certificates were inspected and evidenced that the equipment was subject to regular checks, these included the gas safety certificate electrical testing and water tests. Care Homes for Older People Page 23 of 29 Evidence: The fire extinguishers had been serviced August 08 and other fire equipment September 08. Fire drills were recorded with staff signatures as confirmation of attendance. These were conducted fairly regularly however the manager must ensure that all staff including domestics, cooks and administration staff are adequately trained in fire procedures. The employers liability certificate was on display and current. In relation to self monitoring and auditing of the service these processes were limited and did not reflect that the views of all those involved with the service, were taken into account. Quality assurance measures should include the views of all those living in the home and those who are involved with the service. The quality assurance records seen demonstrated there was a lack in such input from those persons. There were few records in respect of meetings either between staff and the manager, or residents and the manager. Meetings seemed to be relay information i.e. one set of minutes, a meeting with the cook, referred to the EHO report. There seemed limited opportunity for two what discussion and exchange of information or ideas. There were some notes on a relatives /residents meeting November 08. In addition we were advised that another meeting had taken place early 09. The manager stated that as she operated a open door policy, most relatives came to see her when they wanted to and that these meetings also formed part of the discussion regarding the placement and care plan. The minutes of a staff meeting held 7/1/09 had a list of bullet points although no notes of the discussion or actual content of the meeting. The supervision records which have been previously referred to also illustrated little in the way of two way discussion. There were no Regulation 26 reports on site although the manager stated that they had been conducted and that she could send them in. Regulation 26 visits must be conducted monthly and a report on the findings made and supply a copy to the manager of the home for them to action any areas which need. Residents financial records were retained in a book where records and receipts for expenditure were retained. Care Homes for Older People Page 24 of 29 Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Residents health and personal care must be fully documented in order that it can be addressed by staff in the home. To ensure that all residents health is maintained and individual to their specific needs. 30/09/2009 2 9 13 All medication practices, 30/04/2009 administration and record keeping must be addressed with due care and attention and within requirements and guidelines. To ensure that residents are receiving the correct medication at the correct time 3 12 12 Residents should be enabled 30/09/2009 and assisted in decisions on how they spend their day including activities, meals and provision of health care. Care Homes for Older People Page 27 of 29 To ensure residents maintain independence and a sense of well being. 4 18 13 Staff need to be fully 30/09/2009 conversant in dealing with abuse and whistle blowing in order to take the appropriate action. Staff who have sufficient knowledge will recognise it and act appropriately 5 19 23 The programme of refurbishment and upgrading must continue. Residents need to live in a home which is well maintained comfortable and meets their needs. 6 33 24 A system for reviewing the 30/09/2009 services provided in the home needs to be expanded upon to included an annual review that includes a written report and actions to be taken. To ensure all parties, residents and others,are included in the service developments . 30/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - 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. You have been warned!