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Inspection on 02/09/05 for The Grange Nursing And Residential Home

Also see our care home review for The Grange Nursing And Residential Home for more information

This inspection was carried out on 2nd September 2005.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents at The Grange were positive about the standards of care in the home and about the staff. It was clear that there were good relationships between residents and staff. The atmosphere in the home was calm and relaxed. The home was generally clean, bright and well maintained, providing a pleasant environment for residents.

What has improved since the last inspection?

The home had met three of the four requirements made at the last inspection, resulting in improvements to the facilities offered to residents. A second activities coordinator had recently been appointed, improving the level of service offered to residents.

What the care home could do better:

There were a few gaps identified in the care records. Action was needed to ensure residents` needs were fully assessed and care planned accordingly. Medication administration records also had some gaps in recording which needed addressing to ensure residents` safety and welfare. There were some problems with the storage of medication in the home. The ground floor storage room was too warm, above the recommended storage temperature for some medication. In the first floor storage room, a cupboard needed repair and the fridge needed defrosting and records of temperature checks kept up to date to ensure correct storage of medication. Some of the cupboards in the ground floor storage room were generally in need of repair or replacement as the doors and drawers were loose and ill-fitting.There were two ground floor toilets which needed redecoration. Some fire doors had been wedged open, creating a potential fire safety hazard. Some bed rails were seen to be in use without protective padding to reduce the risk of injury to residents. Staffing levels in the home needed to be reviewed against the dependency levels of residents to ensure that residents` needs could be properly met. It was clear that staff were dissatisfied with staffing levels and felt that the workload could be managed more effectively to improve the service offered to residents.

CARE HOMES FOR OLDER PEOPLE The Grange Care Centre Field Drive Shirebrook Nottinghamshire NG20 8RL Lead Inspector Rose Veale Unannounced Inspection on 02 September 2005 at 10:00 am 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 Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Grange Care Centre Address Field Drive, Shirebrook, Nottinghamshire, NG20 8RL 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) 01623 747070 01623 746513 Southern Cross Care Management Limited Vacant Care home with nursing 50 Category(ies) of Older person,(OP) 49, younger adult (YA) 1 registration, with number of places The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 Place for (YA) for named person, (identified in the proposal notice), for as long as they are accommodated at the home. Date of last inspection 31/01/2005 Brief Description of the Service: The Grange Care Centre is situated in village of Shirebrook, near to local shops, pubs and public transport. The home provides personal and nursing care and accommodation for up to 49 older people, plus 1 place for a named person under the age of 65. All residents are accommodated in single rooms with ensuite toilets. The home has lounge and dining areas suitable for use by small or larger groups of residents. There is a large garden area with patios accessible to residents. The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 7 hours on one day. There were 40 residents accommodated in the home on the day of the inspection, including 12 residents assessed as needing nursing care. Residents, visitors and staff were spoken with during the inspection. The care records of 4 residents were examined, plus other records relating to the staffing and management of the home. A tour of the home was undertaken. The acting manager was available and very helpful throughout the inspection. Since the last inspection, a site visit had taken place to look at proposals for the development within the home of a specialist unit for people with dementia. What the service does well: What has improved since the last inspection? What they could do better: There were a few gaps identified in the care records. Action was needed to ensure residents’ needs were fully assessed and care planned accordingly. Medication administration records also had some gaps in recording which needed addressing to ensure residents’ safety and welfare. There were some problems with the storage of medication in the home. The ground floor storage room was too warm, above the recommended storage temperature for some medication. In the first floor storage room, a cupboard needed repair and the fridge needed defrosting and records of temperature checks kept up to date to ensure correct storage of medication. Some of the cupboards in the ground floor storage room were generally in need of repair or replacement as the doors and drawers were loose and ill-fitting. The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 6 There were two ground floor toilets which needed redecoration. Some fire doors had been wedged open, creating a potential fire safety hazard. Some bed rails were seen to be in use without protective padding to reduce the risk of injury to residents. Staffing levels in the home needed to be reviewed against the dependency levels of residents to ensure that residents’ needs could be properly met. It was clear that staff were dissatisfied with staffing levels and felt that the workload could be managed more effectively to improve the service offered to residents. 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 Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 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 standard(s) 3 Satisfactory assessment information had been obtained prior to the admission of residents, ensuring that the home could meet their needs. However, residents had not received written confirmation of this from the home. EVIDENCE: The care records of four residents were examined. All the records seen contained assessment information obtained prior to the admission of the resident. This information included the Community Care Assessment and the assessment carried out by the manager of the home. None of the records seen had a letter from the home to the resident confirming that their needs could be met by the home. There was also assessment information collected soon after admission to the home, including nutritional, tissue viability, and continence assessments. These assessments had been reviewed and updated monthly in three of the records seen. (The fourth record was of a resident admitted less than a month prior to the inspection). Each resident had a care plan produced from the assessment information. The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 and 10 Residents’ health and personal care needs appeared to be well met, with good liaison with other healthcare professionals and evidence of respecting residents’ privacy and dignity. However, there were gaps identified in care and medication records. EVIDENCE: The care records of four residents were examined and each had a care plan. The care plans seen covered all the relevant activities of daily living and included detailed action required by staff to meet the residents’ assessed needs. One care plan seen did not include the pressure area care required by the resident, even though a pressure sore risk assessment had been carried out and indicated a high risk of developing pressure sores. One care plan for a resident admitted two weeks prior to the inspection had not been fully completed. All the care plans seen were signed and dated and one had been signed by a relative of the resident. Review meeting notes were seen and showed that residents and / or their relatives had been involved in care reviews. The care records included details of contact / input of other healthcare professionals, such as GP, District Nurse and chiropodist. One care record showed that the resident’s recent weight loss and poor appetite had been The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 10 followed up by the home as the resident had been seen by the GP and then referred to the dietician. Residents spoken with confirmed that they had access to services such as chiropody, dentist and optician. The policy and procedure for the handling of medication in the home was seen. This was generally satisfactory, although the policy did not say that medication should be kept in the home for 7 days following the death of a resident, or until it had been established that a coroner’s inquest would not be held. The home had a copy of the Royal Pharmaceutical Society guidelines for the safe handling of medication in care homes, and also had reference books available for staff. The medication administration records, (MARs), were examined. Nearly all the MARs included a photograph of the resident, with the exception of two newly admitted residents. Some of the MARs had gaps where there should have been a signature of the person administering the medication, or a code letter to show why the medication had not been given. A code letter had been used on one MAR that was not explained on the record. Some MARs had handwritten entries which were not signed by the person writing them or countersigned by another member of staff to show they had been checked as correct. The storage of medication was inspected. There were two clinical rooms used for the storage of drugs, one on the ground floor and one on the first floor. The ground floor room was used for storing the drugs for the residents assessed as needing nursing care, and also the Controlled Drugs. The ground floor clinical room was very warm, despite an extractor fan installed in the ceiling and a free-standing fan. (There was no window in the room). Records had been kept of the temperature of the room and these showed that the room had been at 30 degrees centigrade for at least a week prior to the inspection. There were medications stored in the room which stated on the packaging they must be stored below 25 degrees centigrade. The acting manager said that this problem had been brought to the attention of the providers. The storage and recording of Controlled Drugs was satisfactory. The fridge temperatures had been recorded daily and were satisfactory. The first floor room, also used as an office, stored the medication for residents assessed as needing personal care only. The fridge in this room needing defrosting and daily temperature checks were not up to date. This was particularly important as the fridge was used to store insulin. There was a drawer front missing to a cupboard in the room used to store liquid medicines, allowing unrestricted access to the medication. The care plans seen referred to maintaining the privacy and dignity of residents. Residents spoken with felt that staff treated them with respect and ensured privacy during personal care. A visitor spoken with felt that staff showed a respectful and caring attitude to residents. It was observed during the inspection that staff knocked on bedroom doors before entering. Staff The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 11 spoken with were clear on how to ensure residents’ dignity and privacy, and how to maintain independence. It was clear that there were good relationships between residents and staff. The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 12 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) 15 Residents were provided with appealing, nutritious meals in a pleasant environment. EVIDENCE: The dining rooms were bright and cheerful with the tables attractively laid. The lunch-time meal was observed in the first floor dining rooms. A small dining room had been arranged for four male residents who enjoyed eating together. These residents said the food was good with choices offered at every meal. They said there was always plenty of food and enjoyed second helpings. Other residents spoken with said the meals were good. The larger dining room on the first floor felt quite busy and a little noisy during the meal as care assistants tended to call across the room to residents to ask about their choices, rather than go to the resident to ask. Residents who needed it were helped unobtrusively by staff sitting with them. The meal looked appetising and was well presented. The staff spoken with were knowledgeable about the dietary needs and preferences of residents. The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 13 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 procedure was clear and robust to ensure effective use by residents and their representatives. EVIDENCE: The complaints procedure and complaints records were seen. The complaints procedure was satisfactory, except that it referred to National Care Standards Commission, rather than Commission for Social Care Inspection. The complaints records showed that complaints had been satisfactorily dealt with in the required timescales. One resident spoken with was aware of the complaints procedure. One visitor spoken with was aware of the procedure but had never made a complaint. The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 14 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, 24 and 26 The home was generally clean, well-maintained and comfortable, providing a pleasant environment for residents. EVIDENCE: The home was generally well maintained and well decorated. The lounges and communal areas were comfortably furnished. Two ground floor toilets needed redecoration as wallpaper borders had peeled off and paintwork was scuffed and flaking. As identified under Standard 9, a drawer front in the first floor office / drug storage room needed to be repaired or replaced. Some cupboard doors and drawer fronts in the ground floor drug storage room needed to be repaired or replaced as they were loose and ill-fitting. The laundry room door and some bedroom doors were held open with wedges, creating a potential fire safety hazard. A requirement made at the last inspection to ensure the temperature of water was safe had been met as thermostatic valves had been repaired or replaced. The home had a car park to the front and a large garden to the back of the building with patio areas for residents to use. The acting manager said that The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 15 work would be starting soon on a new fence to enclose the garden and ensure residents’ safety. The bedrooms seen were clean, pleasant, well decorated and personalised with residents’ own furniture and possessions. Two requirements made at the last inspection had been met – to provide suitable beds for all residents needing nursing care, and to provide locks for all bedroom doors. One resident spoken with was pleased with the new bed provided. It was observed that some bed rails were in use without protective padding, or ‘bumpers’ to protect residents from possible injury, even though the care plans seen specified that bed rails must always be used with bumpers. The home was generally clean and free from offensive odours on the day of the inspection. The floors in the larger dining room and adjacent kitchen appeared in need of cleaning when seen before lunch-time. The laundry was clean, tidy and well equipped. The acting manager said that staff had not had specific training regarding the control of infection, although this was covered in the induction training. The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 16 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 Staffing levels needed to be reviewed against the assessed dependency of residents and in consultation with staff to ensure that the home could fully meet residents’ needs. EVIDENCE: The staff rota for the home was seen. Although the staff hours provided appeared acceptable, there was clearly dissatisfaction amongst staff about staffing levels in the home. It was felt that the hours provided did not truly reflect the dependency levels in the home. Staff felt that this was particularly a problem at night. The night staff worked from 8pm to 8am and so were on duty at two of the busiest times of the day, helping residents to bed and to get up in the morning. There were a total of four staff on duty at night, (sufficient for the number of residents in the home), but because the home was on two floors, it was necessary to have two staff on each floor. It was felt that the workload on the first floor was too much for two staff to effectively cope with. Residents and a visitor spoken with said that staff always seemed busy, although residents felt that they did not have to wait too long for help from staff. The care records seen contained dependency assessments for each resident, but this information was not readily available for the home as a whole. A requirement has been made in this report for the home to provide this information. A discussion took place with the acting manager regarding staffing levels and possible ways of improving the situation. It was also felt to be a problem that the team leader on the first floor was always included in the care hours and so had little or no time to complete The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 17 administration tasks. In addition to providing care and support for the residents, the team leader was expected to keep the care plans and assessments up to date, order medication, and liaise with others involved in the care of residents, such as District Nurses, care managers and GPs. On the day of the inspection it was noted that the team leader had to work longer than the planned shift to complete administration tasks. It was felt that it would be beneficial for the team leader should have a number of designated ‘office hours’ per week, supernumerary to the care staff on duty. The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 18 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) 31 and 35 There was a satisfactory policy and procedure in place to ensure residents’ financial interests were safeguarded. EVIDENCE: The acting manager had been in post for about six months. She had applied for registration with CSCI, but the process had been held up by waiting for references. A requirement made at the last inspection that a registered manager must be in post has therefore not yet been met and has been carried forward in this report. The manager said she was hoping to commence the Registered Manager’s Award in September 2005. Residents felt that the manager was approachable and accessible. Staff felt that the manager was involved and interested, and that they could go to her with any concerns or problems. Records were seen of residents’ personal money held by the home. The home discussed keeping personal money with residents on admission to the home and a consent form was signed by the resident if they wished the home to The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 19 provide this service. The money was kept securely in a safe, and detailed records were kept by the home’s administrator. Residents or their representatives were provided with a monthly statement. The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 20 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 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x 2 x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 x x x 3 x x x The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 21 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)(d) Requirement The registered person must confirm in writing to the resident that the care home is suitable to meet the assessed health and welfare needs of resident. All residents must have a care plan detailing how all their assessed needs will be met Medication Administration Records must be signed when medication is given, or a code used to show the reason why the medication was not given The registered person must ensure that the storage facilities for medication are secure The registered person must ensure that medication is stored according to the directions stated on packaging, i.e. at the correct temperature Daily maximum and minimum temperatures must be recorded for the medication fridge on the first floor and must lie between 2 and 8 degrees C The two ground floor toilets must be redecorated Fire doors must not be wedged open Bed rails must always be used Timescale for action 31/10/05 2. 3. 7 9 15(1) 13(2) 31/10/05 31/10/05 4. 5. 9 9 13(2) 13(2) 31/10/05 31/10/05 6. 9 13(2) 31/10/05 7. 8. 9. 19 19 24 23(2)(d) 13(4)(a) (c) 13(4)(b) 30/11/05 30/09/05 30/09/05 Page 22 The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 (c) 10. 11. 26 27 13(3) 18(1)(a) 12. 31 8 and 9 with suitable padding or bumpers Staff at the home must 31/12/05 undertake suitable training in the control of infection The Registered Person must 14/10/05 provide details to CSCI of the dependency levels of all service users at the home, and details of the care hours provided The Registered Person must 31/10/05 ensure that a Registered Manager is in post. Original timescale 31/04/05 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. 6. 7. 8. 9. Refer to Standard 9 9 9 9 16 19 27 27 31 Good Practice Recommendations The homes policy regarding the administration of medication should state that medication should be retained in home for 7 days following the death of a resident. The fridge used to store medication on the first floor should be regularly defrosted to ensure effective working Code letters used on Medication Administration Records, (MARs), should be explained in the key on the record Handwritten entries on MARs should be signed by the person writing them and countersigned by another member of staff who has checked the entry as correct The homes complaints policy should be amended to refer to Commission for Social Care Inspection, rather than National Care Standards Commission The cupboard doors and drawers in the ground floor drug storage room should be repaired or replaced Shift times and staff hours should be reviewed in consultation with staff to provide better cover at busy times Consideration should be given to providing supernumerary hours for the team leader on first floor to allow for administration tasks The acting manager should commence the Registered Managers Award before the end of 2005 C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 23 The Grange Care Centre The Grange Care Centre C52 C02 S2082 The Grange Care Centre V247632 020905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection South Point Cardinal Square Nottingham Road Derby, DE1 3QT 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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