Inspection on 29/09/08 for St Vincent`s Nursing Home

This inspection was carried out on 29th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Vincent`s Nursing Home 08/01/07

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 17/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Vincent`s Nursing Home Wiltshire Lane Eastcote Pinner Middlesex HA5 2NB     The quality rating for this care home is:   two star good 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: Clare Henderson-Roe     Date: 0 2 1 0 2 0 0 8 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. the things that people have said are important to them: They reflect 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 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: St Vincent`s Nursing Home Wiltshire Lane Eastcote Pinner Middlesex HA5 2NB 02088724900/90 02088685347 shiria.halsey@svnh.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Shiria Halsey Type of registration: Number of places registered: St Vincent`s Hospital care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The Registered Person may provide the following categories of service only: Care home with Nursing - Code 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 Dementia - Code DE (maximum number of places: 5) The maximum number of service users who can be accommodated is: 60 Date of last inspection Brief description of the care home St Vincents Nursing Home is a purpose built home and is registered to accommodate 60 service users with nursing care needs. The home has been built on the site of the old St Vincents Hospital and has a long Roman Catholic tradition, started in 1907. The home has a chapel where daily mass is celebrated. The home offers quality Care Homes for Older People Page 4 of 27 Over 65 0 60 5 0 Brief description of the care home accommodation to members of religious orders, retired priests, laity workers and to people from any religious background that wish to live within this peaceful environment. The home has four units, each one with its own facilities. All the bedrooms have en suite facilities to include toilet, wash hand basin and shower. The communal rooms are spacious and there the gardens are well maintained. The home is situated in a quiet residential area of Eastcote and there are local public transport links with a bus stop near to the home. Car parking space is available. The current fees are eight hundred and sixty five pounds per week for permanent placements and one hundred and forty pounds per day for respite care. Care Homes for Older People Page 5 of 27 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: two star good 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: This was an unannounced key inspection carried out as part of the regulatory process. A total of 27 hours was spent on the inspection process and was carried out by 2 Regulatory Inspectors and an Expert by Experience. We carried out a tour of the home and service user plans, medication records & management, staff records, financial & administration records and maintenance and servicing records were viewed. The Expert by Experience spent time speaking with residents, the activities co-ordinator and generally observing the daily routine of the home. We spoke with several residents and staff, plus one visitor. The Annual Quality Assurance Assessment (AQAA) document completed by the home, plus comment cards from residents, staff and healthcare professionals have also been used to inform this report. Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 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. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 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 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are fully assessed prior to admission, thus the home ensures they are able to meet each persons needs. Evidence: We viewed pre-admission assessments on each wing. These had been completed, and although some varied in the level of detail, the Registered Manager explained that it depended on the detail available at the time of assessment. Overall they provided a picture of the resident and their needs and the home could ascertain if they were able to meet their needs. Where possible a copy of the Social Services assessment is also obtained. Care Homes for Older People Page 11 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service user plans were being completed to provide staff with the information to meet each residents needs effectively. There were some shortfalls identified in the management of medications and this could place residents at risk. Staff care for residents in a caring, gentle and professional manner, thus respecting their privacy and dignity. There is limited information regarding the wishes of residents and their representatives in respect of end of life care, thus they are at risk of their wishes not being fully met. Evidence: We viewed a sample of service user plans on each Wing. Overall these had been well completed and provided a good picture of each resident and their needs. Several care plans viewed were very personalised to reflect individuality and the residents preferences. There was evidence that the documentation had been reviewed monthly and also whenever there was a significant change in a residents condition. Care plans had also been reviewed following a return from a hospital admission. There was improved evidence of input from residents and their representatives and further work Care Homes for Older People Page 12 of 27 Evidence: is being done in this area. Risk assessments for falls were in place and in most cases these had been updated following any falls. Information regarding falls risk was also contained in the care plan for mobility and the occurrence of falls had been recorded in the care plans and the daily record. Assessments for moving & handling, nutrition, continence and pressure sore risk had been completed and where issues were identified this had been recorded on the care plans. There was evidence of regular reviews and where issues had been identified, for example, weight loss, there was clear evidence of input from the GP and relevant healthcare professional. Moving & handling equipment to be used for each individual had been identified and recorded, and this was also the case with pressure relieving equipment in use. Wound care documentation was viewed and although a document for wound and pain assessment had been completed, some of the records for dressing changes were difficult to follow. Action was taken to address this by the second day of inspection. Assessments for the risks associated with the use of bedrails were seen, and the need to ensure that the assessment includes initial identification of the appropriateness of their use was discussed. By the second day of inspection an additional risk assessment for the use of bedrails had been formulated and this is being worked on to provide a good assessment tool. Written consents for the use of bedrails were seen. There was evidence of input from healthcare professionals to include GP, dietician, tissue viability nurse, optician and dentist. We viewed medication records and management on each Wing. Medications are being securely stored and there is an approved controlled drug medication cupboard for each floor. Lists of specimen signatures and initials for registered nurses were in place, however the lists were incomplete and the Manager said that these would be updated. Liquid medications had been dated when opened. The home uses a 28 day monitored dosage system, plus some medications are supplied in boxes. Several residents are self-medicating, and risk assessments are in place for this, plus each resident has a lockable space for the storage of their medications. Single use lancing devices were available for use for blood glucose monitoring, and for those residents able to carry out their own blood glucose tests the devices are kept by each individual. On two Wings some gaps were noted in the signing for receipts and administration of medications. Also, stock supplies had not been carried forward and therefore it was difficult to audit the stock against the administration records. One set of eye drops being used had been open for more than the 28 days accepted timescale for use. For one medication that is given weekly, it was noted that only a 5 day gap had occurred between administrations and this was pointed out and to be addressed. For residents who are having medications crushed for ease of swallowing, this had been identified in the medication records, and care plans were formulated to identify and address this need. Temperature checks of the clinical rooms and medication fridges are carried out daily Care Homes for Older People Page 13 of 27 Evidence: and in some instances these were outside the recognised safe ranges. There had been a situation where a supply of medication had been transferred from one resident to another, which is not accepted practice, however it was ascertained that this had been done in conjunction with the GP and the Primary Care Trust in an exceptional circumstance. Medication records viewed on the other Wings were up to date and no gaps in receipt and administration were noted, and where medications had been omitted the correct coding had been used. Medications for disposal are clearly recorded and a coding system is used for the reason for disposal. On the second day of inspection the Manager produced an action plan to address the shortfalls identified. Staff were seen caring for and conversing with residents in a gentle, professional and caring manner, respecting their privacy and dignity. Residents spoken with expressed their satisfaction with the home and said that they were being very well looked after. All residents are referred to using their preferred term of address. Bedrooms were personalised and looked very homely. Personal clothing is appropriately labelled. A telephone is supplied in all bedrooms and there is no charge for incoming calls. Residents can choose to have the facility for making outgoing calls and are charged accordingly. The expert by experience spoke with several residents and an observation was: The residents are able to choose what time they get up or go to bed On the admission page of the service user plan the section regarding the residents end of life wishes had been completed. This information is quite brief and the need to ascertain and record the wishes of of residents and their representatives in the event of health deterioration and end of life care was discussed. It was noted that for some of the residents information regarding their wishes for deterioration in health had been ascertained and recorded, however this needs to be in place for all, and if a resident is not ready to discuss this sensitive topic then this should be recorded. There was evidence of some training for registered nurses in procedures associated with end of life care, however overall the staff had not received training in this area and this is to be progressed. The home does receive input from the Macmillan Nursing Team. Care Homes for Older People Page 14 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activity provision for the home is very good, providing a variety of activities, outings and entertainments to meet the residents individual needs, to include religious needs. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Information regarding advocacy services is available, thus ensuring the residents right to independent representation is respected. The food provision in the home is of a good standard, offering variety and choice with residents choices being respected. Evidence: The home has a full time activities co-ordinator. Activities programmes were on display throughout the home and there was evidence of group and individual activities taking place. The expert by experience spoke with the activities co-ordinator, and made the following observations: The activities lady has a planned weekly programme of activities which covered a wide range of subjects from crosswords to line dancing, or trips on a canal boat. Birthday parties, film shows and live entertainments are also arranged. There is a very active gardening group who helped in the extensive garden, particularly in the greenhouse and with the raised beds. Handicrafts are encouraged and there are many residents who make cards or dressed dolls in preparation for the Care Homes for Older People Page 15 of 27 Evidence: Christmas Bazaar. For those that do not wish to partake in any of the activities the activities co-ordinator has 1:1 sessions. There is a log of activities and who had taken part. The families of residents are encouraged to provide input as to what hobbies their loved ones were interested in and the residents are encouraged to continue if at all possible. Other observations were made by the expert by experience in respect of residents religious care needs: There is a strong Catholic ethos as many of the residents are from the local Abbey or Convent, with prayers and daily mass presided over by the Father who lives in a house next door to the site. Most residents who are able to attend do so, but if unable to, the service can be viewed on the TV screen in their bedroom. Even though there is a strong Roman Catholic flavour, other faiths are treated appropriately and not ignored. The home has an open visiting policy and visiting is encouraged. Visitors are made welcome at the home and refreshments are provided. We observed good interaction between residents, visitors and staff. The home has information on display regarding advocacy services. Religious sisters from the Community House provide advocacy services for the religious sisters living at the home. Comments from the surveys reflect that advocates are very pleased with the care provision at the home. We viewed the kitchen and cleanliness is maintained at a very high level. Cleaning schedules are in place and adhered to. There was a good supply of fresh, dried, tinned and frozen produce. Fresh fruit and vegetables are available daily. The chef has been in post for a few months and has worked on producing new menus in line with residents preferences. 2 main choices are available for lunch, however individual alternatives are provided if people do not like either option. We sampled the lunchtime options and the meals were well presented and tasty. Several comments were received regarding the fact there had been an improvement in the meal provision, and this evidenced that issues previously raised had been addressed by the home. There is always a home made soup available as part of the suppertime meal. Each Wing had a kitchenette where residents, visitors and staff can make snacks and drinks, and there are risk assessments in place. The lunchtime meal was viewed and meals to include pureed meals were well presented. Residents were enjoying their meals and there was a very sociable atmosphere. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure in place to address any concerns raised by residents and their visitors. Policies and procedures are in place for safeguarding adults, thus protecting the residents. Evidence: The home has a complaints procedure and this is on display in the home. The home records every issue raised and deals with them promptly. There was evidence that written concerns are responded to promptly in writing. The surveys received indicated that residents are very clear on how to raise a complaint and issues raised are addressed. The home has a safeguarding adults policy and also a copy of the Hillingdon Safeguarding Adults procedures. Staf spoken to were clear to report any concerns and understood the Whistle Blowing procedures. Staff have received training in safeguarding adults. Care Homes for Older People Page 17 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has been purpose built to a very high standard, is very well appointed, thus providing a good quality clean, safe and homely environment for residents to live in. Infection control procedures are in place and being adhered to, thus safeguarding the residents. Evidence: The home has been purpose built to a high standard. All bedrooms are single with ensuite facilities to include toilet, wash hand basin and shower. Bedrooms have been very tastefully furnished and quality flooring has been used throughout. The home has a maintenance man and any repairs are carried out promptly. The communal areas are spacious and the home is bright and airy throughout. The gardens are very well maintained and a greenhouse with wheelchair access has recently been installed. The home has CCTV for the entrances and grounds. The home and surroundings are of a high quality and provide a very pleasant, safe and homely place to live in. In addition to the en suite shower facilities, each Wing has 2 assisted bath facilities which are of a high standard, to meet the needs and wishes of the residents. The laundry room was clean and tidy. Cleaning schedules are in place throughout the home and are adhered to, and the home was very clean and smelled fresh throughout. Care Homes for Older People Page 18 of 27 Evidence: The expert by experience commented There is a house keeper who has a staff of 5 who do a good job to keep the place clean and sweet smelling. All the rooms and corridors are cleaned daily. Systems are in place for infection control and these are adhered to. Protective clothing to include gloves and aprons are available. Training in infection control is given to all staff as part of their induction process. Infection control is being well managed at the home. Care Homes for Older People Page 19 of 27 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. The home is appropriately staffed to ensure that the needs of the residents can be met at all times. Systems for vetting and recruitment practices are in place to safeguard residents. There is a training programme in place to provide staff with the skills and knowledge to care effectively for the residents. Evidence: The home has a philosophy of accommodating residents of varying dependencies on each Wing, and the staffing is kept under review in accordance with resident dependencies. The home was being staffed appropriately to meet the needs of the residents, to include nursing, care, administration and ancillary staff. The Manager had completed the AQAA document and this recorded that over 50 of the care staff are qualified to NVQ in care level 2 or above. Some Wing Leaders are in the process of undertaking NVQ assessor training. We viewed 3 sets of staff records. These contained the information required, however the information in respect of health is very brief and this is to be expanded to include a health questionnaire. It is acknowledged that for the first year of the home opening all staff were seen by Occupational Health prior to commencing employment. The Manager said that she would ensure the required information is obtained for all staff. Care Homes for Older People Page 20 of 27 Evidence: The home uses the Skills for Care Common Induction Standards induction booklet and all new care staff complete this. In addition, for staff who have not worked in the care industry before a competency programme for care assistants is also completed, covering aspects of care at a more basic level. Staff spoken with said that they receive good training input. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team have the skills and experience to manage the home effectively and ensure good outcomes for the residents who live there. Sytems for quality assurance are in place, however findings are not always followed up, thus the process of review and feedback is incomplete. The home does not hold monies on behalf of residents and procedures in place ensure the residents needs are met. Health & safety is being well managed at the home, thus safeguarding residents, staff and visitors. Evidence: The Manager is a first level registered nurse and completed the Registered Managers Award in June 2008. She has also undertaken periodic training to include topics relevant to her role. The management structure for the home is a Manager, Deputy Manager and 4 Wing Leaders. Residents spoken to said that the management staff are approachable and deal with any issues raised. One comment received was: The Manager and management team are very approachable and they are very constructive in their outlook. They encourage team building and sharing of knowledge. Care Homes for Older People Page 22 of 27 Evidence: The home does not have a annual development programme for quality assurance in place as yet, however it does cover several aspects of quality assurance. These include regular meetings for staff, residents and representatives. There is an annual programme of audits covering all aspects of the home. Hillingdon Social Services also carry out an annual audit and action is taken to address any shortfalls identified. The management team had carried out audits of care plans and medications and identified shortfalls, however it was not clear how these had been followed up to ensure they had been addressed. The home does not hold monies on behalf of individuals. Any expenditure is paid out by the home and then residents or their representatives are invoiced at the end of each month. Receipts are available for all monies paid on behalf of or given to residents. The records viewed were clear. We sampled maintenance and servicing records and those viewed were up to date. Risk assessments were in place for equipment and safe working practices. The last Fire Risk Assessment was carried out on 21/09/07 and action had been taken to address the shortfalls identified. Staff had received training in health & safety topics and updates are in the process of being arranged. The maintenance man explained that the hot water temperatures are carried out annually in each Wing. We discussed the importance of ensuring the checks are carried out within the current guidance and he said he would check with current relevant legislation. Hot water flow and return temperatures are carried out weekly and are within safe range. Fire drills are carried out 6 monthly and the majority of staff rotate between day and night duty. Clear records of each drill are maintained and recommendations are made to address any shortfalls identified at the time of the drill. The maintenance man agreed to discuss frequency of drills with the Fire Safety Officer for the home to ensure they are meeting current legislation. Care Homes for Older People Page 23 of 27 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 24 of 27 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 9 13 All medications must be administered in accordance with the prescribers instructions. So that all residents receive their medication as prescribed. 14/10/2008 2 9 13 All receipts and administration of medications must be signed for. To provide a clear audit trail of all medications prescribed for each resident. 05/12/2008 3 9 13 There must be a list of specimen signatures and initials for all staff involved in the administration of medications. To clearly identify the person administrating each medication. 05/12/2008 4 11 12 Information regarding each residents wishes in the event of deterioration of 06/12/2008 Care Homes for Older People Page 25 of 27 health and their care in their final days are ascertained and recorded. Staff must receive training in end of life care. To ensure their wishes are recorded and respected, and that staff have the skills and knowledge to care for residents appropriately. 5 33 24 The home must have a system in place for quality assurance. To ensure that all areas of the home are audited and action taken to address any shortfalls identified. 05/12/2008 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 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) 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 27 of 27 - 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!