Inspection on 30/08/05 for The Elms [Stonehouse]

This inspection was carried out on 30th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 Elms [Stonehouse] 08/09/08

The Elms [Stonehouse] 08/10/07

The Elms [Stonehouse] 16/10/06

The Elms [Stonehouse] 27/02/06

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 Gloucestershire GL10 2NP Lead Inspector Ruth Wilcox Unannounced 30 August 2005, 08.30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Elms Address Elm Road Stonehouse Gloucestershire GL10 2NP 01453 824477 01453 791813 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Orders of St John Care Trust Mrs Sylvia Jean Bridgland Care Home with Nursing 45 Category(ies) of OP Old Age (45) registration, with number of places The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 One named service user under 65 years old to be accommodated. 2 The registered Manager must commence the NVQ 4 Registered Home Managers Award in 2005. Date of last inspection 8/3/05 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 wash basin 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 D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector conducted this unannounced inspection over 7.25 hours on two days in August. As part of the inspection work, an investigation was also carried out into concerns raised in a complaint by a previous respite service user’s relative. Care records, the opportunities for residents to exercise personal choices, and the standard of food were inspected, as were the arrangements for the recruitment, provision and supervision of the staff. The overall management of The Elms was looked at, including the management of residents’ personal monies, where applicable. A tour of the premises took place, with particular emphasis on the upkeep and cleanliness of the environment, and staff were observed going about their duties whilst interacting with the residents. The care of four residents in particular was closely looked at, and this included the care records relevant to the complaint investigation. Fourteen residents were spoken to directly to obtain their view of the care and services they receive in the home; the complainant’s views and experiences also are contained in this report. There was direct contact with the home manager and her deputy, two nurses and three care staff, and the administrator all of whom were cooperative with the inspection process. Interviews were conducted with the majority of these staff as part of the complaint investigation. The complaint was made by the relative of a respite service user further to their dissatisfaction about certain aspects of their care during their stay at The Elms in May 2005. The five elements of the complaint are as follows: 1. Despite the service user’s illness, and his request for a Doctor, one was not called to see him during his stay 2. The service user was in urinary retention on discharge, necessitating intervention and treatment by the District Nurse 3. The service user was constipated on discharge, necessitating intervention and treatment by the District Nurse The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 6 4. The complainant was assured by staff on admission that the service user would be given drinking straws to assist him to drink, and this did not happen, resulting in him becoming dehydrated 5. The service user had a pressure sore on his sacrum when he was discharged from the home. All elements of this complaint are upheld, and a number of statutory requirements are issued within this report, with which the home must comply in order to make the necessary improvements. What the service does well: What has improved since the last inspection? On the basis of the staff audit indicated above, additional staff have been provided, with a view to residents’ needs being met in a more timely and appropriate manner. A second qualified nurse is currently working during the morning, and the manager anticipates that this can become a consistent feature for the future. Since the last inspection some new hospital type beds have been purchased, and some redecoration has taken place, with more to follow on the basis of the environment audit reported above. The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 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 D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 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 standard(s) 3. The omission by the home to conduct a pre-admission assessment consistently, has resulted in a small number of residents’ needs not being met. EVIDENCE: Two pre-admission assessments were seen for two of the residents. Each was drafted in a different format, and had been carried out whilst the prospective residents were in hospital, prior to their discharge to The Elms. The pre-admission assessment arrangements for respite clients are under review, following recent shortfalls in this system being identified. Respite clients were not being assessed prior to their admission in cases where the clients were already known to the home from a previous visit. This had resulted in changing needs going unrecognised by the home. The Elms does not provide intermediate care. The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 & 10. There is no clear or consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet residents’ needs. The failure by staff to follow the safe systems for managing medications could compromise the safety of residents. The staff are generally mindful of residents’ privacy and dignity, however there are isolated instances when personal support is not offered in such a way as to promote the dignity of some. EVIDENCE: The vast majority of residents have a personal plan of care, which has been devised on an assessment of their needs. Four were chosen as part of a case tracking exercise, with one of these chosen on the basis of the complaint investigation. Care plans, such as they were, had not been reviewed consistently, some not being reviewed for three months. The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 11 Care plans contained some degree of evidence of how individual health and personal needs are to be met, with some risk assessment work carried out where applicable. However there were some very evident and serious shortfalls in this process. In one case the ‘activities of daily living’ assessment demonstrated the high level of needs the person had; there was no associated care plan to demonstrate how these were to be met. This person was at risk of falling and at risk of developing a pressure sore, and there were no associated plans of care for these identified risks. A wound care plan was no longer applicable in the same format due to the person’s recently changed needs. In another case a resident had some mental health needs requiring the community psychiatric nurse intervention; there was no record of the outcome of such intervention reflected in the care plan or its review. In the third case an assessment recorded that help was required with personal hygiene, mobility associated with a risk of falling, and the prevention of a pressure sore; there were no care plans recorded in any of these cases. A fluid and food monitoring chart had been commenced, but this had not been properly and consistently completed. Daily records showed evidence of other specific health needs being attended for which there were no plans of care documented. In the case of a respite service user, inspected as part of the complaint investigation, there were no recorded care plans at all for staff to follow. A superficially completed activities of daily living assessment was undated, making it impossible to know if it had been relevant at the time of the last respite stay. One particular staff interview indicated that the home would follow the Social Services care plan in such a case. Inspection of this showed that this plan would not have been relevant in this case, as it pre-dated the time of the respite stay in question by almost a year; many aspects were not reflective of the person’s needs at all. Daily records were uninformative, and there was evidence that medical intervention had not been sought appropriately when the person was unwell. A member of staff said that the resident concerned had a vulnerable and sore area on their sacrum, which had warranted some treatment; there was no record of this. Different staff had different recollections of the care this person had actually required, and in the absence of proper recording it was clear that there were serious shortfalls in the way this person’s care had been managed during their stay. Standard 9 was not inspected in detail in a general sense, but was inspected from the complainant’s point of view. The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 12 Medications had been received into the home for the resident, but there was no record of receipts. Medications were handwritten on the charts, and the author had not signed the entries at all, had not dated them, and had not identified the route for administration. A second person had not signed as a witness to the handwritten entries. A prescription only item had been used to treat a vulnerable pressure area, though this had not been prescribed for the resident, and there was no record of it being used. Staff were observed interacting with residents, and were respectful and attentive. Residents in the main spoke very positively about the staff group, saying that they were ‘very good’, ‘wonderful’, and confirming that staff were generally respectful of their privacy and dignity. One person said that they ‘could not be in a better place’, and another said that ‘she was treated like a queen’. One person however did not speak positively. The resident said that ‘good care was patchy’, because some staff were ‘rude and disrespectful’. The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 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 standard(s) 14 & 15. Isolated incidents of residents being unable to exercise control in their daily lives, has resulted in those who are more dependent feeling less able to make choices. Dietary needs of residents are well catered for in the main, with a balanced and varied selection of food available that meets their tastes and choices; however the omission by staff to provide residents with the support equipment they require to drink has had an adverse impact for at least one person. EVIDENCE: Residents were seen in various locations in the home, generally pleasing themselves what they were doing, within the limits of their abilities. Residents can clearly choose where they spend their time, and staff were heard making choices available to people. Three residents said that they could ‘do as they pleased’, with others indicating that they have a good degree of choice regarding how and where they spend their time. The person referred to under standard 10 also had some dissatisfied comments regarding choices. The person said that residents are left sitting in the dining room, whilst they wait an unacceptably long time to return to their rooms after The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 14 a meal, and that residents have to wait a long time for their call bell to be answered; this applied to those residents who are more reliant on the staff for moving them around the home. The contents of residents’ rooms confirmed that they can exercise some choice in their private space, and there was evidently a choice at meal times. The service of the lunchtime meal was seen in the spacious dining room, and there were at least three different main meals being served. The meal looked appetising and nutritious, and special diets were catered for. Staff were providing assistance where needed, and in most cases there was pleasant interaction going on between residents and staff. Residents confirmed their satisfaction with the quality and quantity of the food provided for them. With regards to the complaint investigation there is no evidence to suggest that the resident was consistently given the drinking straws that had been requested for him, to assist him with drinking his fluids. The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 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 standard(s) 16. The complaints process in this home is poor, with evidence of little confidence among some residents and relatives that their concerns are listened to or appropriately acted upon. EVIDENCE: The written Complaints procedure was not displayed on the notice board, and was not very easily accessible in the Statement of Purpose, which was placed on the table in the entrance hall either; this procedure did not contain the CSCI’s contact details; on the second day of this inspection, this had been rectified. The complaint investigated as part of this inspection had ultimately been made to the CSCI because the complainant had not received a timely response from the home after raising the complaint with them. One resident expressed some doubt about staff taking her concerns seriously, or about the home doing anything about resolving them particularly. The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26. The residents are provided with a safe, clean and comfortable place in which to live, though some attention to areas requiring repair or refurbishment will further improve this. EVIDENCE: Since the last inspection an audit has been undertaken regarding the standards of furnishings, fixtures and fittings provided in the home; priority areas have been identified. Eight hospital type beds have been purchased, and a redecoration programme has begun in some areas; other areas have also been scheduled for redecoration and refurbishment in addition to this. Following this inspection there are some maintenance repairs currently required; the window restrictor was not functioning in one room, the dining room curtains are unsightly, having been damaged in the laundering process, and the patio door blinds are in a poor state of repair. The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 17 On the day of this inspection it was very hot, and part of the dining room is housed in a conservatory. Ceiling blinds protect residents to a degree from the direct sun; the patio doors can be left open, though plans to make the courtyard/patio area secure by enclosing it have not yet been implemented. The home is cleaned to a satisfactory standard, and is generally tidier and more organised at this time. The laundry was orderly, and infection control procedures are observed in here. There are appropriate systems for dealing with clinical waste, however, the collection bins were very dirty and unhygienic around the lids and exterior, and one bag was poorly secured, resulting in the contents spilling out. The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29. A review of staffing levels and deployment aims to ensure that residents’ needs can be met in a timely and consistent way. Isolated gaps in the recruitment procedures must be addressed if the appropriate safeguards for the protection of residents are to be consistent. EVIDENCE: There have been recent reviews to the way in which staffing is provided and deployed at The Elms. The manager is endeavouring to have two nurses on each morning shift, and since the last inspection there is an additional carer on duty at this time as well. This has been in response to the high dependency levels among residents, and the subsequent impact on staff ability to meet needs in an appropriate and timely way. Staffing is reduced in the afternoon and evening, and overnight, but is deployed in such a way as to provide appropriate cover at various times. It was reported that work patterns are also being reviewed, with an emphasis on the actual use of time and the nurses’ responsibilities. An ancillary team provides support to the nursing and care team, with cleaning and laundry staff, catering and maintenance staff, and an administrator. The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 19 The records of the most recently recruited members of the team were inspected, and in the main these demonstrated that staff are recruited in accordance with robust procedures. There were however isolated incidents of where this was not so. One record did not contain a photograph of the worker, and in the same case there was an incomplete employment history and no documentary evidence of the worker’s qualifications that were declared on the application. The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35 & 36. There are some good management systems in place to ensure that the welfare and rights of the residents are safeguarded. The way in which staff are supervised is not sufficient to provide them with clear guidance regarding working practices. EVIDENCE: The overall management of The Elms is now provided by The Orders of St John Care Trust, and evidence of robust financial and business management systems was inspected as part of the recent registration process. The administrator is receiving additional training in order to manage some increased responsibilities regarding invoicing and financial issues in the home. Some residents have placed personal money and valuables with the home for safekeeping. Thorough records for each person, which include transaction details, running totals, and receipts, are kept. Residents or their The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 21 representative have signed to acknowledge some transactions, but where this has not been possible in the majority of cases, two staff members sign the record to witness on behalf of the resident. A written policy demonstrates a commitment to the formal supervision of staff, but the implementation to date is not in accordance with it. Most staff have received an annual appraisal, and some have received a supervision session, though there are a number who have not. A detailed matrix or monitoring tool is not yet in use for this programme, and it does not appear that staff will receive the six supervision sessions recommended under this standard. One nurse said that it could prove problematic to ensure the proper supervision of staff during the course of their work, due to time constraints and other necessary work demands placed upon them. With further consideration to the complaint investigation, there is evidence that staff were not given sufficient guidance on how best to manage the resident’s health and personal care. The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 2 COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x 3 3 1 x x The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14(1.a) Requirement The Registered Person must not admit any service user to the home unless their needs have been fully assessed. The Registered Person must ensure that staff prepare written care plans as to how residents needs in respect of their health and welfare are to be met. The Registered Person must ensure that staff keep care plans under review. The Registered Person must ensure that staff keep detailed records and plans for residents in respect of any nursing or specialist health care that they receive. (previous timescale of 30/4/05 not met) The Registered Person must ensure that staff devise written care plans on the basis of a risk assessment identifying a risk of the resident falling or developing a pressure sore. The Registered Person must ensure that staff carry out and record assessments for all residents at risk of falling. The Registered Person must Timescale for action 30/9/05 2. 7 15(1) 30/9/05 3. 4. 7 7 15(2.b) 17(1.a) Schedule 3 30/9/05 30/9/05 5. 8 15(1) 30/9/05 6. 8 13(4.c) 30/9/05 7. The Elms 8 17(2. 30/9/05 Page 24 D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Schedule 4(13) 8. 8 12(1.a) 9. 8 17(1.a) Schedule 3(3.n) 13(2) 10. 9 ensure that staff maintain fluid and food monitoring charts consistently and in full, in cases where this is applicable. The Registered Person must ensure that the home is conducted so as to promote and make proper provision for the health and welfare of residents. (this is with reference to residents access to external health care services). The Registered Person must ensure that a record of any pressure sore is maintained, which includes a record of the treatment provided. The Registered Person must ensure the following in the management of medications: 30/9/05 30/9/05 30/9/05 11. 10 12(4.a) 12. 14 12(2) 13. 15 16(2.i) 1. Staff must record all receipts of medications 2. Staff must sign in full for any handwritten entries on medication charts 3. Staff must record the start date of medications, and identify the route for administration when hand writing medications on charts. 4. Staff must not use prescription only items for residents for whom they have not been prescribed. The Registered Person must 30/9/05 ensure that staff conduct themselves in a manner which consistently upholds the dignity of all the residents. The Registered Person must 30/9/05 enable residents to exercise their choices, and make decisions with respect to their care and welfare. The Registered Person must 30/9/05 ensure that appropriate eating and drinking aids are provided to residents, where needed. Version 1.40 Page 25 The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc 14. 16 22(3) 15. 19 23(2.c) 16. 26 13(3) 17. 29 19(1.b.i) Schedule 2. 18. 36 18(2) The Registered Person must ensure that any complaint received is fully and appropriately investigated. The Registered Person must ensure the following repairs are undertaken: 1.The missing window restrictor in the identified bedroom must be replaced or repaired 2. The dining room curtains and door blinds must be replaced or repaired. The Registered Person must ensure that bins used for clinical waste collection are kept clean, and can fully and securely contain any contents. The Registered Person must ensure that the following are obtained for each member of staff employed in the home: 1. A photograph 2. A full and complete employment history 3. Documentary evidence of qualifications. The Registered Person must ensure that staff are appropriately supervised. 31/10/05 30/11/05 31/10/05 31/10/05 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. The Elms Refer to Standard 7 7 9 16 36 Good Practice Recommendations Care plans should be reviewed on at least a monthly basis. All assessments should be dated when undertaken. A second person should sign as a witness to any hand written entries on medication administration charts. The home should display the complaints procedure to make it more available to residents and their representatives. Formal staff supervision should be given at least six times D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 26 6. 36 each year, and should include aspects of working practice, philosophy of care and career development needs. A matrix or monitoring tool should be devised in order to monitor the homes progress with the staff supervision programme. The Elms D51_D03_S64620_The Elms_v241570_UI_300805_stage 4.doc Version 1.40 Page 27 Commission for Social Care Inspection 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. 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