Inspection on 10/10/05 for The Cedars

This inspection was carried out on 10th October 2005.

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

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

Other inspections for this house

The Cedars 30/09/09

The Cedars 26/09/07

The Cedars 26/10/06

The Cedars 25/04/06

The Cedars 05/05/05

The Cedars 25/01/05

The Cedars 13/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Cedars 45 Queens Road Oldham OL8 2AH Lead Inspector Carol Makin Unannounced Inspection 10th October 2005 9:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Cedars Address 45 Queens Road Oldham OL8 2AH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01616264665 0161 626 4665 Mrs Eileen Ashton Mrs Eileen Ashton Care Home 12 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (4), Old age, not falling within any other of places category (12) The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 12 OP, up to 2 DE and up to 4 DE(E). No service user to be admitted into the home under 60 years of age. A Manager, working a minimum of 30 hours each week, must be in place at all times who has the qualifications, skills and experience necessary for managing the home and who is registered, or has an application for registration pending, with the Commission for Social Care. 5th May 2005 Date of last inspection Brief Description of the Service: The Cedars is a small, family run care home for up to 12 service users. The home is situated one mile from Oldham town centre, close to local amenities and public transport. Accommodation is provided in six single bedrooms, four of which have en-suite toilet facilities, and three twin rooms with en-suite toilets. Privacy screens are provided in the shared rooms. There is a large lounge and a lounge/dining room; there is also a small separate lounge at the rear of the property which is a designated smoking area for service users. Level access to one of the dining rooms is not provided, service users must negotiate one step; grab rails are in place for those service users who may need assistance. The front of the home provides a large garden area overlooking the park with seating areas for service users. A small amount of car parking space is available at the rear of the property. The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 10th October 2005. The Inspector was accompanied by a Pharmacist Inspector who assessed the management of medication in the home. Action had been taken in relation to some of the requirements, which were made as a result of previous inspections. Some had been fully addressed, but others required further improvement to meet the National Minimum Standards and the Regulations. Some requirements could not be checked on this inspection, and some of the standards could not be assessed, because the records were not available. The manager was away on holiday at the time of the inspection, and the deputy manager, Joan Thorpe, was in charge of the home at the time, assisted by a senior carer. The inspector spoke with some of the residents, the deputy manager and members of care staff, carried out a partial inspection of the premises, and examined records. Verbal feedback of the findings of the inspection was given to the deputy manager and a senior carer, during the inspection. What the service does well: What has improved since the last inspection? A programme of enclosing radiators for safety reasons had been completed. Some cosmetic repairs had been carried out to bedroom furniture. A toilet seat had been replaced and a toilet frame had been repaired. The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 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 the following standard(s): 3 Resident’s needs are not consistently assessed before they move into the home. EVIDENCE: A sample of residents care files, were examined during the inspection. One file contained needs assessments, which had been done before the prospective resident was admitted to the home, although this had been delayed because of an admission to hospital. The assessment and care plan on another file was done on the day of admission to the home, and the community care assessment and care plan was faxed to the home on the same day. Intermediate care is not offered at The Cedars. The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 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 the following standard(s): 7,8 and 9 Recording in relation to care planning and health care monitoring, did not demonstrate that all of the health, personal and social care needs of residents are met. The home’s practice and procedures for dealing with medicines were unsafe. EVIDENCE: The care plans which were in place on residents’ files which were inspected, contained some good, detailed information. However they had not been consistently reviewed each month, or consistently signed by the residents and/or their representative to confirm that they had been involved in the process. Residents weight had not been recorded on admission or consistently afterwards. One example of this, which was of particular significance, was noted in the records of a resident, for whom diet and weight loss were issues. The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 10 Whilst action had been taken regarding this, e.g. involvement of a relevant health professional, and the provision of food supplements, weight records had not been kept as required, despite the fact that it was noted in the care plan that the resident needed to be weighed once a month, or more frequently if necessary. Regular checking and recording of residents weight is needed to assist in monitoring their general health and wellbeing, and assessing the effectiveness of any measures taken to address issues regarding weight loss or gain. Some daily reports and weight records had been written in pencil. This is not an acceptable practice, as a permanent record is needed. (See standard 37). The storage, administration, and recording of medication was assessed by a Pharmacist inspector, and a number of concerns were identified. Records for the administration of medication had not always been completed, and some medication had not been administered as prescribed. Medication was not securely stored which put residents at risk. The following are examples of some of the issues identified: Tablets prescribed to be administered to a resident three times a day 20 minutes before food, were being administered at the same time as other tablets prescribed to be administered three times a day with or after food. A resident had been provided with 3 bottles of medication, which had been previously prescribed and dispensed for another resident. The medication was kept in the resident’s room for her to self-administer as required during the day. The medication was not prescribed for this resident and was not listed on the medication administration record chart. Eye drops which were prescribed for a resident to be administered four times a day, were actually being administered once a day at night by the resident’s son. The medication administration records inaccurately showed that the eye drops had been administered by staff four times a day as prescribed. Medication kept by the home is mainly stored in a cupboard in the hall. During the inspection the door to this cupboard was left unlocked. It was also noted that some medication was lying out of its’ container on the desk in the office during the inspection. When the inspectors enquired about this they were informed that it belonged to a member of staff who had left it out with the intention of taking it. Staff must not leave their medication out in the home as it poses a risk to residents. The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 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 the following standard(s): 14 Residents were able to exercise choice within the home. EVIDENCE: Residents gave examples of how the daily routine within the home was flexible, and enabled them to make choices, e.g. “You can please yourself when you get up and when you go to bed”, “ I can stay in my room, and go down to the lounge in the afternoon to play dominoes, quizzes, or bingo if I want to”, “There are trips out if you want to go on them”. One resident chose to have her lunch in her bedroom. Residents were also able to bring in furniture and other personal possessions of their choice to meet their needs. Standards 12,13,15, all of which were met on the last inspection, were not reassessed on this inspection. Reference was, however made to certain aspects of these standards during the inspection, and the comments subsequently made by residents, were positive. The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Information about the procedure for making complaints was not clear. Staff need the necessary training, to protect residents from abuse. EVIDENCE: A complaints procedure was available, but it needed amending to clarify that complaints can be referred to the Commission for Social Care Inspection at any stage, and deleting the reference to the National Care Standards Commission. A book for recording complaints was available but it was blank, and the deputy said that no complaints had been made to the home. Discussion with staff revealed that training in relation to the protection of vulnerable adults had been included in their NVQ (or equivalent) training, which for some staff was in 2003. Up to date training is needed for all staff to ensure that they are able to recognise different forms of abuse, and to know what do if an incident of abuse was to occur in the home. The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,24,25 and 26 The environment was not fully maintained to ensure the welfare of residents. The temperature controls on radiators were not accessible. Bedrooms and communal areas were clean, homely, and pleasant. EVIDENCE: Since the last inspection, requirements for hazardous products to be stored in locked facilities, a toilet seat to be replaced, and toilet frames to be repaired, had been addressed. The work to enclose radiators had been completed, but the deputy manager reported that the joiner had not returned to make the necessary alterations to allow access to the controls so that the heat can be adjusted. Some damaged vanity units and bedside cabinets had been cosmetically repaired, with the exception of the doors on a vanity unit in a double bedroom. The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 14 The emergency call point in one of the bedrooms which were seen during the inspection, had fallen off the wall. The owner/manager must ensure that all emergency call points are firmly attached to the wall at all times. The bedrooms which were seen during the inspection, were clean and free from offensive odours. The décor was colourful and very individual, and residents had furniture and other personal possessions in their rooms to meet their needs and make them homely. Most of the residents who spoke with the inspector were satisfied with their rooms, but one lady said that she didn’t like the fire escape in her room because she was afraid that ‘someone would get in’. The inspector passed these concerns on to the senior carer, and discussed the need for a risk assessment to be completed regarding the issues relating to the fire escape being in the resident’s room, including the risk of falling down it. The premises were overall clean and hygienic with the following exceptions: There was a strong, offensive odour, and small flies in the office, most of which were in region of a waste paper bin. The deputy manager discovered that the source of the problem was a discarded food container in the bin. She explained that the staff were not responsible for cleaning the office, as the manager dealt with it herself. This matter had implications for health and hygiene, as a member of staff reported that the strong odour had affected her breathing. In addition to this, the office is very small and has no ventilation, and the door is therefore kept fully open during the day, and the office is in close proximity to the kitchen and a resident’s bedroom, the doors of which were also fully open on the day of the inspection. Flies from the office were seen to fly into the kitchen, where there was some uncovered food, (see standard 38) It was also noted that there was food debris on the place mats on the table in the dining room, which made them ‘sticky’ to the touch, and the cloth was stained and had crumbs on it. (see standard 38). The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 and 30 The staffing rota did not accurately reflect the staff on duty in the home. Overall, residents liked the staff. The practice for responding to the emergency call system was sometimes unsafe. Staff training in certain areas needed to be improved. EVIDENCE: The rota for the week of the inspection showed the manager as being on duty, but she was away on holiday until 18/10/05. The deputy manager and a senior carer were shown as doing sleeping in duty on alternate nights during the week, but during the inspection the inspector learned that it was in fact the owner’s daughter who was on call in the home, to assist the carer on waking duty if necessary, because she lives in the flat on the top floor of the home. The staffing rota must be an accurate reflection of the members of staff who are on duty in the home during the day and the night. The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 16 A member of staff was observed turning off the emergency call bell at the control box, and delaying attending to the resident. This is an unsafe practice, and it had implications for staffing levels in the home, There were 2 members of staff on duty in the home at the time, one carer was ironing in the hallway, and the other carer had gone to the cellar to bring up some food. Some residents were upstairs in their rooms and others were in the lounges at the time. Residents’ comments about the staff included “ they are very nice”, “staff are lovely”, “ they are sociable, and helpful”, “some of them are alright”, ”they’re a bit short staffed now, but a man is starting soon, and it should be better then”, and “there’s only one on at night, but staff are very nice and they do their best.” The deputy manager and the senior carer reported that 7 of the 8 care staff employed in the home had an obtained NVQ 2 or equivalent qualification. The deputy manager said that no new staff had been recruited since the last inspection, although they were in the process of appointing a carer when the checks had been done. The records for the applicant consisted of the application form, and photocopies of I.D. There was no information to show whether applications for references etc, had been made. As the records were incomplete recruitment procedures could not be fully assessed on this inspection. There was, however an issue about the way in which the applicant’s records were kept, which is detailed in standard 37. Certificates of various training courses which staff had attended over the years, were displayed in the home. Some training, in particular ‘safe working practices’, needed updating (Standard 38). Training needs in relation to the protection of vulnerable adults was also noted previously in this report (standard 18). The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 38 The confidentiality of some records was not maintained due to practices in the home. Record keeping needed to be improved to safeguard resident’s rights. Food hygiene practices could be improved. Staff needed training in safe working practices. EVIDENCE: The manager has previously said that she was considering retiring in 2005. To date she has not provided the Commission for Social Care Inspection with any definite information about this. She must clarify her intentions about retirement, or state how she intends to meet standard 31 by the end of 2005. The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 18 Staff were not aware of any business or financial plans being available in the home. Money held in safe keeping for residents by the home and the accompanying records, were not available for inspection. The deputy manager said that she didn’t have access to them when the manager was away, but she was given a ‘float’ of £75-00 in case any residents needed any of their money during that time. Staff said that since the last inspection, they had received a session of formal supervision from the manager, but the relevant records could not be found at the time of the inspection. The records relating to an application for a job in the home, previously noted in relation to standard 29, were left out on the desk in the office amongst other papers, and various other items, which has implications for confidentiality. Records required by regulation must be maintained in accordance with the Data Protection Act 1998 and other statutory requirements. Issues relating to health and hygiene have been reported on previously in this report, (Standard 26). As previously noted in this report (standard 30), there was a need for staff to have updated training in relation to safe working practices, which are as follows: Moving and handling Food hygiene Fire Procedures First aid Infection control Health and Safety The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 2 X 2 2 2 STAFFING Standard No Score 27 2 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X 1 2 The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement The registered person must ensure that a pre-admission assessment of residents needs has been completed to ascertain whether the care home is suitable for meeting the resident’s needs in respect of health and welfare. The registered person must ensure that care plans are drawn up with the resident, and agreed, signed and dated by the resident whenever capable, and/or their representative (if any). The registered person must ensure that care plans and risk assessments are reviewed to meet the changing needs of residents and routinely, at least once a month. The registered person must ensure that residents weight is recorded on admission and subsequently, and monitored, and any concerns investigated. The registered person must ensure that the medicines policy is developed and expanded to DS0000005488.V249677.R01.S.doc Timescale for action 31/10/05 2 OP37OP7 15 31/10/05 3 OP37OP7 15 31/10/05 4 OP8OP37 14 31/10/05 5 OP9 13 (2) 10/01/06 The Cedars Version 5.0 Page 21 6 OP9 13 (2) 13 (4) c 7 OP9 13(2)17(1 )(a)Sch3 3i 8 OP9 13(2) 17(1)a Sch3 3i 13 (2) 9 OP9 10 OP9 13 (2) 11 OP9 13(2) 13 (4) c 12 OP9 13 (2) 13 OP9 13(2) 13(4)c reflect current guidance issued by the Royal Pharmaceutical Society and comply with the National Minimum Standards. The registered person must ensure that the homely remedy policy is rewritten to reflect current guidance. The registered person must ensure that homely remedies are not administered to residents without prior consultation with the resident’s pharmacist or general practitioner as appropriate. The registered person must ensure that an accurate dated and permanent record is maintained of all medication received or disposed of by the home in order to maintain a complete audit trail of medication. The registered person must ensure that medication administration records are completed accurately and contemporaneously. The registered person must ensure that care home staff administer medication as per a recommended medication administration procedure. The registered person must ensure that all medication is administered to residents as prescribed. The registered person must ensure that medication in the custody of the home, is stored securely and is not accessible to unauthorised persons. The registered person must ensure that medicines in the custody of the home are stored at a temperature that does not exceed 25oC. The registered person must ensure that all items of DS0000005488.V249677.R01.S.doc 13/12/05 15/11/05 18/10/05 18/10/05 18/10/05 18/10/05 15/11/05 18/10/05 Page 22 The Cedars Version 5.0 14 OP9 13(2) 18(1)c,i. 15 OP9 13 16 OP16 22 17 OP18 23 18 OP22 13,16,23 19 OP22 12,13 20 OP24 16,23 medication which have exceeded their expiry dates, do not belong to current residents or are not labelled with prescribed directions are returned to the supplying pharmacy. The registered person must ensure that that the expiry dates of medicines stored within the home are checked on a regular basis. The registered person must ensure that all staff members employed by the home, with responsibility for medication administration have received appropriate training. The training must also include a formal assessment of competency. The registered person must ensure that staff do not leave their medication out in the home, as it poses a risk to residents. The registered person must ensure that the complaints procedure is amended in accordance with the National Minimum Standards and the Regulations. The registered person must ensure that all staff receive training regarding Abuse and the protection of vulnerable adults. The registered person must ensure that emergency call points are securely fixed to the wall at all times. The registered person must ensure that the emergency call bell is not turned off from the main control point before the member of staff has responded to the call. The registered person must ensure that furniture in service users’ private accommodation is well maintained at all times. DS0000005488.V249677.R01.S.doc 13/12/05 31/10/05 13/12/05 09/01/06 31/10/05 31/10/05 01/12/05 The Cedars Version 5.0 Page 23 21 OP24 13 22 OP25 23 23 24 25 OP26 OP38 OP27 23(2)(d)1 6 (j) 13,16 17(2) Sch 4 26 OP31 9 27 OP7OP8OP 17 9OP24OP29 OP35OP36 OP37 28 OP30OP38 12,18 The registered person must ensure that risk assessments are completed in relation to the fire escape, which is located in a resident’s bedroom. The registered person must ensure that radiator temperature controls are accessible so that the heat can be adjusted. The registered person must ensure that all parts of the care home are kept clean at all times. The registered person must ensure that food is not left uncovered. The registered person must ensure that the staff rota is an accurate reflection of the members of staff who are on duty in the home during the day and the night. The registered person must write to the Commission for Social Care Inspection to clarify her intentions about retirement, or state how she intends to meet national minimum standard 31 by the end of 2005. The registered person must ensure that records required by legislation are maintained in accordance with the Data Protection Act 1998 and other statutory requirements, and are available for inspection at all times. The registered person must ensure that staff receive updated training in relation to all safe working practices. 31/10/05 01/12/05 31/10/05 31/10/05 31/10/05 15/11/05 31/10/05 01/03/06 The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 24 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 Refer to Standard OP9 Good Practice Recommendations The registered person should ensure that the directions of medication prescribed as ‘as directed’ are clarified with the resident’s General Practitioner and the prescriptions altered accordingly. The registered person should ensure that stocks of medication are rotated regularly and that stock is checked each month prior to medication ordering to prevent the build up of excess medication. 2 OP9 The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 The Cedars DS0000005488.V249677.R01.S.doc Version 5.0 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. You have been warned!