Inspection on 27/02/06 for The Elms [Stonehouse]

This inspection was carried out on 27th February 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Elms [Stonehouse] 08/09/08

The Elms [Stonehouse] 08/10/07

The Elms [Stonehouse] 16/10/06

The Elms [Stonehouse] 30/08/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Elms Elm Road Stonehouse Glos GL10 2NP Lead Inspector Mrs Ruth Wilcox Announced Inspection 27th February 2006 09:00 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 Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Elms Address Elm Road Stonehouse Glos GL10 2NP 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) 01453 824477 The Orders of St John Care Trust To be appointed Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user under 65 years old to be accommodated. This condition will be removed once the named service user reaches 65 years or no longer resides at the home. 30th August 2005 Date of last inspection Brief Description of the Service: The Elms is a purpose built care home, which provides personal and nursing care for 45 older people over the age of 65 years. The home also has two beds that are designated for respite care within that number. The home is situated in close proximity to the amenities of the local town, and is managed by The Orders of St John Care Trust. A Registered Nurse is on duty twenty-four hours each day, and there are waking night staff. For those residents receiving personal care only, nursing support is provided from community resources. The full range of health care services is available to all residents in the home, and people can register with the local GP of their choice. The accommodation is provided in single rooms, and is situated on two floors, which are accessible using a shaft lift or stairs. Two rooms have an en-suite facility, though all other rooms have a washbasin in situ, with a toilet in close proximity. Communal bathrooms are spacious and provide assisted bathing facilities. Communal space comprises of three lounges, a designated smoking lounge, and a large dining area. There is a small garden and enclosed courtyard at the home, which residents can use if they wish. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this announced inspection over 7.5 hours on one day in February. The temporary acting manager was present throughout the day, providing information as requested. The inspector is grateful to this interim manager for her professionalism and cooperation with this inspection. Care records and the systems for the management of medications were inspected. The care of four residents was closely looked at in particular, and there was direct contact with at least thirteen residents, three visitors and five other staff. Their views regarding the standards of services and care at the home were sought wherever practicable, and the home’s own systems for monitoring the quality of the service were considered. The arrangements for residents to make personal choices regarding social opportunities were inspected, including the arrangements for them to receive their visitors. The procedures for dealing with complaints, and policies for protecting the rights of vulnerable residents were inspected. Staff provision and the arrangements for their training, supervision and development were looked at. The management arrangements for the home were inspected, and a tour of the premises took place, with particular attention to the standard of maintenance, cleanliness and health and safety. What the service does well: Residents spoke positively about the care they receive, and the relationships they share with the regular staff at The Elms. Visitors too expressed their satisfaction with the way in which they are welcomed into the home, and about the care and attention provided by the regular staff. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 6 Staff were observed to be hard working and attentive on the day of this inspection, and were demonstrating a respectful attitude towards the residents, their care and their choices. Residents have regular opportunities for participating in social activities, and are supported to pursue personal interests. There are robust policies at this home regarding the protection of vulnerable residents, and staff have received additional training in this important area. Staff have access to other good training opportunities, and are encouraged to achieve a care qualification. The home is cleaned to a satisfactory standard, and there is all due observation regarding infection control procedures. Although there are currently only temporary management arrangements here, it must be reported that they are proving to be most effective. The temporary acting manager is to be commended for her strong and stabilising influence in the home. She is providing leadership for the staff team, reassurances for the residents and visitors, and is identifying priority areas for improvements. What has improved since the last inspection? The way in which residents’ needs are assessed is now more consistent and thorough, and newly drafted plans of care for each resident give clearer direction for staff to follow to meet residents’ needs. Residents were very complimentary about a new cook appointment, saying that he is much more accommodating to their needs, and that the food has improved under his management. The acting manager and her line manager have addressed any concerns that have been raised in a robust manner, ensuring an overall improvement in the way in which such issues are dealt with. A new staff supervision programme has been implemented; it will be important that this be maintained throughout the year however. New curtains have been provided in the dining room, some bedrooms and the kitchen have been redecorated, new carpets have been fitted in two bedrooms, and a new and improved call bell system has been installed. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 7 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 Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Improvements and greater consistency in the home’s admission procedure can now ensure that all residents are admitted on the basis of a full assessment of their needs, so that they can receive the care that they require. EVIDENCE: The acting manager has conducted a thorough assessment on prospective residents, prior to their admission to the home. The most recent one was recorded in full detail, and clearly identified that the home could meet the person’s needs. The assessment had been carried out at the person’s previous place of residence. The Elms does not provide intermediate care. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. An improved care planning system can now provide staff with the information they need to meet residents’ health and personal needs more satisfactorily. The systems for the management and administration of medications are generally good, with arrangements in place to ensure that residents’ medication needs are appropriately met, although these could be more comprehensive to ensure consistency for residents in isolated cases. Care and support is generally offered in such a way as to promote the privacy and dignity of the individual. EVIDENCE: Each resident has an individual plan of care, which is primarily based on an assessment of their needs; four were selected as part of the case tracking exercise; each had been regularly reviewed. In order to drive improvements in this area, the acting manager is currently in the process of re-assessing all the residents and re-drafting the care plans on that basis. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 11 One completed record was well written, very comprehensive, and clearly directed the plan of care for staff to follow to meet the needs of the individual. Others yet to be re-drafted still contained some gaps between assessed needs and planned care. These included a dietary plan for one resident, a mobility plan for another resident, and a pressure area care and continence plan for another. These elements of care were actually being provided in practice however, and the acting manager prioritised these particular records for re-drafting as a consequence. Records contained evidence of access to all health care services in the community as required, although it was decided that a medical review was necessary for one particular resident following the case tracking exercise. Care plans for wound management in one case were clearly documented, with wound mapping carried out using photographic evidence, which showed the healing process taking place. Appropriate risk assessments also inform the care planning process. All medications are stored appropriately, with clearly printed Medication Administration Records from the supplying pharmacist; the home has changed its pharmacy supplier, in order that it remains compliant regarding the disposal of waste medicines, in accordance with the Special Waste Regulations 1996. Medication records are thoroughly recorded by the staff, and are generally well maintained. However, there were isolated instances where printed directions for the use of external medications were unclear, with the use of an ‘as directed’ instruction, or without identification of the external site at which to administer it. There was no associated plan of care in every case where a drug was prescribed ‘as necessary’. Variable dosages were not consistently recorded in every case where this was applicable. Boxed and bottled medications were dated on opening to ensure they are not used beyond their expiry date. Two staff sign any additions and amendments when making handwritten entries on charts. Care was delivered to residents in the privacy of their own rooms. When observed at other times, staff were attentive and respectful to them. Care plans are devised in such a way as to be mindful of residents’ choices, privacy and dignity. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 12 Residents themselves indicated that they were satisfied with their care, and confirmed that staff were helpful and caring. One resident said that the staff were very ‘caring’ when they carried out her wound dressings. Another said he felt ‘quite pampered’. Visitors too also expressed their satisfaction with the care their relative was receiving, with two saying that staff were ‘excellent’. One person said that the staff, although ‘respectful’, actually showed the residents ‘a lot of affection’. A third relative, although very happy with the care from ‘regular staff’, had concerns about the care provided at times by agency staff, who are less familiar with the residents. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 13 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): 12 & 13. A varied activities and entertainments programme is offered, in order that residents are provided with regular opportunities for social activity. The visiting arrangements at the home ensure that residents can keep close contact with their families and friends in accordance with their wishes. EVIDENCE: A social activity programme is displayed in the home, which announces the planned events. This programme shows a range of social opportunities to suit a variety of preferences and abilities. Residents themselves spoke positively about the social opportunities, with many choosing to participate, but others choosing not to. Residents were seen gathering in small social groups, with most evidently choosing how and where they spent their time. Some were watching television, others were reading or doing a crossword; a musical entertainment was provided during the afternoon. One resident, whose previous interest had been gardening, said that he planted and tended the tomatoes at the home in the summer. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 14 Two other residents said that they are able to pursue their own particular interests, and that the residents and staff always celebrate particular calendar dates and birthdays with a party. Visitors were seen coming into the home to spend time with their relative according to their wishes. Visitors spoken to during the inspection all confirmed that they felt welcome in the home. Two in particular were very appreciative of being able to participate in the care of their relative, as this was very important to them. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 15 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 & 18. The home has a much improved complaints system, with evidence of residents and visitors feeling that any concerns they may have are listened to and acted upon. The home’s robust adult protection policies and associated staff training give residents assurance that they can expect to live in a safe environment. EVIDENCE: There is a copy of the written complaints procedure in the entrance hall for anyone wishing to use it. The acting manager has set up a designated complaints folder, and records of a small number of recent concerns and complaints were seen, with copies of associated correspondence. Each had been addressed appropriately, with satisfactory resolutions reached. Residents and visitors indicated their confidence in the acting manager and staff to listen and respond to their concerns. A visitor said that the acting manager and staff were very approachable, and would respond very quickly to any issues. The home has written policies and procedures for the protection of vulnerable adults, and has copies of other relevant documents and information available; the acting manager is in the process of providing copies of such documentation for staff to read again, so as to ensure their understanding of them. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 16 Staff have recently attended a full day’s training on recognition and management of abuse, should it occur. This was reported to be a very interactive and lively training session; staff spoke very positively about it, saying that it had been excellent and useful training. Two residents commented that they felt they could ‘trust the staff’. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 17 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 & 26. Although needing some minor maintenance attention, the standard of the environment within this home is generally satisfactory, and provides residents with a comfortable, clean and safe place to live. EVIDENCE: A maintenance person is employed at The Elms, and there is a rolling programme of maintenance and redecoration carried out. Cyclical maintenance records are kept. Since the last inspection some bedrooms have been redecorated, with carpets replaced in two. The kitchen has been repainted, and a new call bell system has been installed. New curtains have been provided in the dining room. Some necessary repairs were noted around the home as follows: The walls in an identified bedroom are badly scored and damaged; The waterproof side panelling on a ground floor bath is lifting off; The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 18 The double glazed unit seal in an identified bedroom is ineffective, and is allowing a very significant build up of condensation to develop between the glass panels, which looks unsightly; A fluorescent strip light in a bathroom was not working; There are no window coverings on the patio doors in the dining room. Other than that, there were other areas of wear and tear evident on paintwork around corridors, but the maintenance person was dealing with this gradually. It was also noted that tablecloths on the residents’ dining tables were very creased, and at least two residents themselves were heard to comment on this. The courtyard and patio were both tidy and well kept. The home was clean throughout, with no odours detected, with the exception of one identified bedroom. Domestic staff work to manage odours, and were shampooing carpets where needed. The laundry room was well managed, with appropriate infection control measures observed regarding foul or infected items. Gloves and aprons are plentiful throughout the home, and there is liquid soap, sanitising hand gels and paper towels conveniently situated. The home has a contract for the handling and collection of clinical waste. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 19 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 & 30. Despite a stable core group of hard working staff, variables in provision and skill mix has resulted in a lack of continuity in the team’s ability to meet residents’ needs consistently, as they would like. Staff receive appropriate training to support them and equip them with the necessary skills for their roles. EVIDENCE: Staff rotas are recorded. These allow for at least one nurse to be on duty at all times, with nine care staff during the morning, six during the afternoon and evening, and three overnight. A second nurse is on duty on two mornings of the week, which appears to give greater stability on the shift, with an improved skill mix of staff. All staff spoken to say that the home is very busy. Staff morale is reported to have been quite low recently, with some having left, and with a very significant amount of sickness absence. As a consequence of this, there have been high levels of agency staff employed. Two visitors, and the staff themselves, expressed some concern about the high use of agency staff recently, saying that they do not understand the needs of the residents in the same way as regular staff. One visitor said that her relative gets frustrated when agency staff do not understand and carry out elements of his care in a way that he is used to. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 20 Another said that agency staff do not react appropriately at times to address her relative’s continence needs, and that on occasions the agency carers seemed to outnumber the regular staff. The acting manager is currently working to address this, and is in the process of recruiting some more regular staff, which is anticipated to resolve the situation. Residents and visitors spoke very positively about the regular staff team, indicating that their needs are generally well met. A fairly new visitor to the home couldn’t speak highly enough of the staff and the care her relative was receiving so far. A good ancillary team of administration, catering, cleaning and laundry staff support the nursing and care team. Several people commented on how good the newly appointed cook is, saying how accommodating he is to their needs, and how the food has improved under his management. Out of the twenty-seven care staff employed, fifteen have an NVQ level 2 qualification, with two of these having a level 3 award. A further one is currently doing the NVQ level 3 training, and three are doing the level 2. Staff have access to training events, coordinated by The Orders of St John Care Trust’s training manager. A calendar of training has been provided, which incorporates a variety of training relevant to nursing and care staff. New staff attend a two day formal induction. An in-house induction programme has yet to be fully developed and introduced with the use of a template to record it. A senior carer confirmed that all new staff work under supervision. Fire safety and manual handling training has been provided in-house, with the care leader being a designated manual handling trainer. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 & 38. Although temporary, there are now effective management systems in place to ensure that the interests, health and safety of the residents are safeguarded, through a programme of quality monitoring, staff supervision and strong leadership. EVIDENCE: The Elms does not currently have a registered manager in post. There are very effective interim management arrangements in place, with an experienced registered manager from another home within the group working here in a part time capacity; this person is already familiar with The Elms, having worked here previously. An appointment to this permanent post has recently been made, and an application to register the successful candidate will be processed by the CSCI upon receipt. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 22 Residents, staff and visitors were very appreciative of the clear leadership provided by this interim manager. One visitor was particularly appreciative of the acting manager’s perceptiveness and accessibility. The acting manager said that she endeavours to remain as accessible as she can, inviting discussion and feedback on care and services from residents as often as possible. Staff meetings have been held, during which the acting manager has shared information and provided clear guidance and leadership for driving improvements in the home. She has also been redefining job roles, with specific action plans for different individuals. Written policies and procedures are being provided in a staggered way, in order for staff to familiarise themselves with them methodically. A residents’ meeting was planned for later in the week, at which individual views are welcomed. ‘Comments and Suggestions’ forms are available in the entrance hall, for anyone choosing to use this method of providing feedback to the home. A quality survey was conducted last year, with the results analysed afterwards for all homes within The Orders of St John Care Trust group. Individual statistics are being provided for each home however, with the home manager expected to draw up an action plan to address any areas of concern from the survey. Meal monitoring forms have been introduced on a random but regular basis, in order that residents’ views about the quality of the food can be obtained. There is a written policy that staff should receive formal supervision at least six times each year; this has not been adhered to, although the acting manager has now introduced measures to ensure that staff are more adequately supervised. A random selection of supervision records show that supervision is given on a one to one basis, with some actually being work practice based. A matrix has been developed for monitoring and planning this programme. There was evidence that health and safety issues are addressed satisfactorily in most regards, with written policies, procedures and risk assessments, provision of necessary equipment and staff training. A full fire safety risk assessment throughout the whole building is due to take place in the immediate future by an external assessor, with due regard to the revised fire safety regulations. Although staff have recently received fire safety training, records show that nothing had been done in this regard for many months previously. There are four members of staff currently qualified to provide First Aid, although this training is now available so that others can be trained. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 23 All necessary safety checks and maintenance of equipment is undertaken in a timely fashion. The acting manager resolved to investigate actions taken under the previous manager in response to the outcomes of the electrical installation safety check last year. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 24 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 4 3 X X 2 X 2 The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP9 OP9 Regulation 13(2) 13(2) Requirement The home must avoid the use of ‘As Directed’ instructions on medication charts. Staff must ensure that there are clear instructions regarding the use of all medications, to include the use of external medications on the medication charts. Staff must record the amount of variable dosages administered on the medication charts, where applicable. The registered person must ensure that: • The scored and damaged walls in the identified bedroom are repaired • The waterproof side panelling on a ground floor bath is repaired • The damaged double glazed unit seal in the identified bedroom is repaired • The fluorescent strip light in the identified bathroom is repaired • Window coverings are provided to the patio doors DS0000064620.V277359.R01.S.doc Timescale for action 31/03/06 31/03/06 3 OP9 13(2) 31/03/06 4 OP19 23(2) (b.c) 30/04/06 The Elms Version 5.1 Page 26 5 OP27 18(1.b) 6 OP38 23(4.e) in the dining room. The registered persons must ensure that the use of agency staff does not prevent residents receiving continuity of care, such as is necessary to meet their needs. The home must ensure that fire safety training is provided consistently, encompassing all staff. 31/03/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP9 OP19 OP36 OP38 Good Practice Recommendations The directions for the use of ‘as necessary’ and/or external medications should be recorded and linked in to a relevant plan of care. Tablecloths used for the residents’ dining tables should be ironed before use. Formal staff supervision should be given at least six times each year, and should include aspects of working practice, philosophy of care and career development needs. • A person qualified in First Aid should be provided on each shift • Fire safety training should be provided to day and night staff six and three monthly respectively. The Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Elms DS0000064620.V277359.R01.S.doc Version 5.1 Page 28 - 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. 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