Inspection on 23/01/07 for The Laurels

This inspection was carried out on 23rd January 2007.

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

The inspector 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 Laurels 12/02/09

The Laurels 11/12/07

The Laurels 18/10/05

The Laurels 16/11/04

The Laurels 05/05/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

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 Laurels Westfield Lane Draycott Cheddar Somerset BS27 3TN Lead Inspector Sally Murphy Unannounced Inspection 10:30 23 January 2007 rd 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 Laurels DS0000043864.V318162.R02.S.doc Version 5.2 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 Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Address Westfield Lane Draycott Cheddar Somerset BS27 3TN 01934 742649 01934 743580 The.Laurels@blueyonder.co.uk 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) Brightwell Residential Care Limited Wendy Caroline Perkins Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th October 2005 Brief Description of the Service: The Laurels is a large detached property situated in the village of Draycott, between Cheddar and the city of Wells. Service user rooms are located on the ground and first floors. There is a stair lift, assisted bathrooms and call bell system available at the home. The Laurels is registered with the Commission for Social Care Inspection to provide care for up to 20 people over the age of 65 years who require assistance with personal care. The Registered Provider is Brightwell Residential Care Limited and the Registered Manager is Wendy Perkins. The home has been decorated and furnished to a good standard. There is a large, cultivated garden and some residents’ rooms have private patio areas. Fees at this home range from £361 to £436 per week with additional charges being made for chiropody, hairdressing, newspapers, personal items and taxis. The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and was completed by Sally Murphy, Regulation Inspector over one day. On the day of the inspection there were eighteen service users residing at the home. The atmosphere was relaxed. Interaction between staff and service users was observed to be friendly and respectful. During the course of the inspection, the Inspector completed a tour of the premises, and met with seven service users and one relative. Discussions were also held with the Registered Manager and three staff members during the inspection. Care practice was observed, and a number of records including care plans, staff files and health and safety records were examined. Prior to the inspection, the Registered Manager completed a Pre-Inspection Questionnaire providing information regarding the service, and information from this document has been included within this report. CSCI sent comment cards (surveys) to Social Workers and GPs who visit service users at this home. Two cards were received from GPs. These both provided positive feedback regarding the home. The Inspector would like to thank the Registered Manager, staff and service users for their assistance during the visit. What the service does well: An assessment of need is completed prior to any service user moving into the home, to ensure that they home will be able to meet their needs. Prospective service users are encouraged to spend time at the home before making the decision to move in. One service user spoken with said ‘you can’t wish for any better’. Service users are able to participate in a range of activities. Service users confirmed that there was always and choice of meal, and said that the food was good, and the menu varied. Service users stated that they are treated with dignity and respect. The home aims to care for service users until the end of their life wherever possible and works closely with the GP and District Nursing service to ensure that service users health needs are met and they remain comfortable. The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 6 Staff are encouraged to study for NVQ qualifications. 14 out of the 18 care staff employed have obtained the NVQ level 2 qualification, and a two have completed the NVQ level 3. What has improved since the last inspection? What they could do better: Care plans must be further developed to ensure that they contain sufficient information to enable staff to fully meet service users’ needs. Care plans must include appropriate risk assessments. A detailed care plan must be developed where a service user has a specific need, such as diabetes. Care plans must be updated to reflect changes in service users’ needs. The Registered Manager must review current practices relating to the administration, storage and recording of medication to ensure that they follow safe practice. All medication must be stored securely. Medication Administration Records must be appropriately maintained. Risk assessments must be completed where service users choose to self medicate. Staff application forms should include a full employment history, so that any gaps in employment can be fully investigated. The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 7 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 summary of this inspection report can be made available in other formats on request. The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 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 Laurels DS0000043864.V318162.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 & 5. (Standard 6 does not apply). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with appropriate information regarding the services and facilities offered at the home. An assessment of need is completed prior to any service user moving in, to ensure that the home will be able to fully meet their needs. Service users are encouraged to visit the home to assess the facilities provided. Service users are provided with a written contract outlining the terms and conditions of their stay. EVIDENCE: The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 10 The home has a Statement of Purpose that provides information regarding the services and facilities. Completed pre-admission assessments were seen within service users’ plans. The Registered Manager advised that prospective service users are invited to visit the home to spend time, or enjoy a meal before moving making the decision to move in. A copy of the written contract was seen, and found to contain all necessary information regarding rights and responsibilities, and any notice periods required. The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans did not contain sufficient information to enable staff to fully meet service users’ needs. Care plans did not address nutritional or pressure sore risk, and did not record plans that were already in place for some service users. One care plan seen had not been updated to reflect changes in this service user’s needs. Not all medication had been stored securely. Medication Administration Records had not been appropriately maintained. Risk assessments had not been completed in relation to service users who self medicate. Service users are treated with dignity and respect. The home offers a good standard of care and support to services users at the end of their life. EVIDENCE: The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 12 Care plans are maintained for each service user. Four care plans were examined in detail during this inspection. Care plans generally provided information regarding the level and type of assistance required by each service user. Moving and handling assessments had been completed, but for one service user this had not been updated appropriately to reflect the change in their needs. Care plans are reviewed on at least a monthly basis. Service users are weighed on a regular basis. One service spoken with confirmed that there were plans in place to help them gain weight, however these were not recorded within the care plan. Without a written plan and a monitoring record the staff and service user would not be able to evaluate the success or otherwise of this plan. Following the inspection, the Inspector was provided with copies of food intake charts for a further service user. These provided a record of the food and fluid taken but did not indicate how this was being monitored, or record the actions being taken when the intake was low. Nutritional risk assessments and pressure risk assessments had not been completed. Risk assessments had been completed for each service user. These addressed areas such as falls, walking unaided and smoking. The Registered Manager advised that there were plans in relating to alcohol for one service user, but these had not been recorded within the plan and could not be used to ensure that a consistent approach was being used to manage this with the service user. Denture cleaning tablets were found within service users en suite bathrooms. These pose a risk of serious injury if swallowed, therefore a risk assessment must be completed in relation to these being available to individual service users. The care plan for one service user who has diabetes did not provide sufficient information to enable staff to fully meet their needs. This must be addressed to ensure that it includes appropriate dietary information, that staff are aware of how often their blood must be tested, what the normal ranges are for that individual, and what they should do if it either rises or falls below this. Service users confirmed that they are able to see a Doctor or nurse when they request. A chiropodist visits the home every six weeks. The home operates a key worker system. The storage, administration and recording of medication were examined. Medication had been stored securely within the locked trolley in the hallway and in the office. Two bottles of Peptac liquid had been left on the bottom of the trolley and were accessible to service users and visitors to the home. This was discussed with the Registered Manager who removed them immediately. The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 13 A sachet of Movicol was found within the drug trolley. This had been removed from original packaging; therefore it was not possible to determine whom this had been prescribed for. Controlled Drugs had been stored securely and appropriate records maintained. The home has a separate fridge for the storage of medication. The lock for this is currently being repaired. An opening date had not been recorded for eye drops. These medications must be disposed of within 28 days of being opened. As there was no opening date recorded it was not possible to determine whether these medications should still be in use. Three medications had labels placed over the box and bottle that only stated the name of the pharmacist. These covered over the labels that stated who the medication had been prescribed for, and the stated dose. Therefore staff would not be able to identify whom the medication was for, or follow the prescribers’ instructions. These were shown to the Registered Manager, who has arranged for them to be returned to the pharmacy for disposal. The fridge temperature had not been monitored and recorded. This is necessary to ensure that the required temperature is maintained at all times for safe storage of medicines. An opening or discard date had not been recorded for prescribed creams stored within service users rooms. The cream found within one service users room had been prescribed for another resident and their name crossed out. Medication Administration Records (MAR charts) were examined. A photograph had been provided on the MAR chart for each service user. Staff had not maintained a record of the quantity of medication being received into the home. The Registered Manager must ensure that an appropriate audit trail is provided so that all medication can be accounted for. This will include maintaining a record of all medication that is returned to the pharmacy. There were 14 occasions with the MAR charts where staff had not recorded a signature to state that the medication had been given, or a definition to indicate why a medication had not been administered. On 8 occasions only the name of a medication, such as ‘Lactulose’, or ‘Co-dydramol’ had been written on the MAR chart. These entries had not been signed or dated and did not include any information regarding the frequency of dose. Therefore it was not possible to determine whether this medication had been administered in accordance with the prescribers’ instructions. Staff had recorded when a course of medication was completed. Variable doses had not been recorded therefore it was not possible to determine whether a service user had exceeded the daily dose for that medication. Risk assessments had not been completed for service users who self medicate. Staff have received appropriate medications training. The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 14 The home has a comprehensive policy regarding the recording, administration and storage of medication. The Registered Manager must review current procedures to ensure that it complies with this policy and ensures safe practice. Service users spoken with confirmed that they are treated with kindness and respect. Service users confirmed that staff always knocks the door before entering. Service users spoke highly of the support provided by staff, and stated that there were ‘considerate to peoples needs’. The home will care for a service user until the end of their life wherever possible. The home works closely with the GP and District Nursing team to ensure that service users receive appropriate health care support and remain comfortable. Staff were providing a high level of support to one service user at the time of the inspection, and had made a bedroom available for their family members, should they wish to rest or spend the night at the home. The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to participate in a range of activities. Service users are supported in exercising choice and their wishes are respected. Meals are of a good standard, and offer a well balanced diet. EVIDENCE: Prior to the inspection, the Registered Manager completed a Pre-Inspection Questionnaire. Within this, it states that the range of activities available include TV, CDs, large print library, puzzles, piano, reminiscence therapy, art therapy musical entertainment, bingo, quizzes and games. The home has also recently acquired plots where flowers can be grown for flower arranging. On the day of inspection service users were listening to music in the lounge, or spending time in their room, as they preferred. Those service users spoken The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 16 with stated that they enjoyed the activies provided and were aware of when events such as exercise, a church service or musical entertainment were taking place at the home. Two service users were receiving day care. One visitor was spoken with during the inspection. They advised that they are always made welcome, and able to speak to staff at the home. Care plans evidenced that service users are encouraged for exercise choice regarding their life and that their choices are respected. For example service users had sometimes chosen not to be weighed, or had chosen alternative menus. The Registered Manager advised that service users had been consulted regarding places that they would like to visit during forthcoming months. Meals are prepared on the premises. Service users are able to eat meals in the dining room or their bedroom, as they prefer. The home is able to cater for specialist diets. Service users stated that there is always a choice of menu, and spoke highly of the meals provided. Wine is always offered at Sunday lunch, and sherry is available at all times. The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has appropriate policies in place to safeguard vulnerable adults. EVIDENCE: The home has appropriate policies relating to the protection of vulnerable adults and whistle blowing. Those service users spoken with stated that they would be able to raise any issues of concern with the Registered Manager or Deputy Manager. Service users stated that they felt their views would be listened to, and any necessary actions taken. The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable environment. There is sufficient communal space and bathing facilities to meet service users’ needs. The home has appropriate infection control procedures, however these had not been fully implemented in some areas. The home was found to have a good standard of cleanliness EVIDENCE: The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 19 Service user accommodation is provided on the ground and first floors. There is a stair lift to the first floor. Assisted bathroom, and a call bell system are also available. There is an ongoing programme of re-decoration and refurbishment at the home. Since the last inspection new flooring had been fitted in the dining room, new carpets fitted in many service user rooms, and five bedrooms redecorated. Communal areas comprise of a large lounge, and dining room. There is a large, cultivated garden that is accessible to service users, and some residents’ rooms have private patio areas. Service users are able to bring personal possessions with them, such as photographs, pictures and small pieces of furniture to individualise their room. The hot water outlet temperature in one bathroom was recorded as exceeding 50 C. It is expected that hot water outlet temperatures would not exceed 43 C. Bathing temperatures had been recorded and were within appropriate limits. The home had been maintained to a good standard of cleanliness. Hand washing facilities consisting of liquid soap and paper towels had been provided for staff in bathrooms, toilets and the laundry. The home must ensure that foot operated flip top bins are available in these areas. Tablets of soap were found within cupboards in each bathroom. These pose a risk of cross infection, and must be disposed of. Service users toiletries must not be available in communal areas. The laundry was clean and well organised. The washing machines have the facility to meet disinfectant standards. The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are appropriate, and flexible to meet service users’ needs. Staff have received the training required to undertake their roles. The home has operated a robust recruitment procedure. EVIDENCE: Duty rotas are maintained. The level of staff is varied to reflect levels of dependency. At the time of the inspection, the number of night carers had been increased to reflect the changes in one service users’ needs. Two staff at the home have obtained the NVQ level 3 qualification, and a further individual is working towards this. 14 out of the 18 care staff employed have completed the NVQ level 2 qualification. This represents a high proportion of the care staff employed, and is to be commended. Staff have recently received updated training on fire safety, manual handling and the protection of vulnerable adults. The Registered Manager has also attended a study day on the Common Induction Standards. The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 21 Two staff recruitment files were examined. One file was found to contain all of the documentation required, including two references, a POVA First check, enhanced CRB and record of induction training. The application form for the second member of staff did not include a full employment history; therefore it was not possible to establish their previous experience of working within a care home, or any gaps in employment. Two satisfactory references and a POVA First check had also been obtained, and this member of staff was working under supervision until the enhanced CRB disclosure was received. The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager is experienced, and approachable. There are systems in place to seek the views of service users. Staff receive appropriate supervision. Equipment servicing records had been appropriately maintained. EVIDENCE: The Registered Manager is Wendy Perkins. She has many years experience of providing care to older people and has been the manager at this home since The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 23 March 2006. Service users and staff members spoken with stated that Mrs Perkins was approachable and that they would be able to raise any issues of concern. Service users are encouraged to express their views regarding the home. A residents meeting was held on 18.1.07. Questionnaires were also sent to service users in July 2006, and positive responses received. The home does not assist any service user in managing their finances. The home displays appropriate Employers Liability insurance. Staff stated that they are provided with good support and receive regular supervision. Records relating to service users are stored securely and appropriately maintained. Fire safety records were examined. The fire risk assessment had been reviewed in January 2006. The fire system had been tested on a weekly basis and appropriate records maintained. The fire system, stair lift, hoist, fire extinguishers and electrical hardwiring had been serviced as required. Accidents had been recorded and reported as required. The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 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. Standard OP7 & OP8 Regulation 15 (1) & 17 (1 & 2) Requirement Care plans must be further developed to ensure that staff are provided with sufficient information to fully meet service users needs. Care plans must: • Be reviewed regularly and updated to reflect any change in service users needs. Include nutritional risk and pressure risk assessments, and where a high level of risk is identified, include plans to meet this need. Include appropriate risk assessments for that individual, e.g. relating to the use of denture cleaning tablets. Include records of specific plans that are in place for individual service users. (For example regarding alcohol for one service Version 5.2 Page 26 Timescale for action 06/04/07 • • • The Laurels DS0000043864.V318162.R02.S.doc user). • Include an appropriate plan for service users who have diabetes. This would include dietary information, the frequency that blood must be tested, the normal limits for that individual, and what action should be taken in the event of levels falling above or below these. 2. OP9 13 (2) The registered person shall make 23/02/07 arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the home. This relates to the need to ensure that: • • All medication is stored securely. The medications fridge temperature is monitored and recorded each day to ensure that medication is stored between 2-8 C. An opening date is recorded on eye drops to ensure that they are not used beyond 28 days of being opened. A record is maintained of all medication entering and leaving the home, including that which is returned to the pharmacy for disposal. A signature is recorded for all medication given or a definition recorded as appropriate to indicate the Version 5.2 Page 27 • • • The Laurels DS0000043864.V318162.R02.S.doc reason for nonadministration. • • Variable doses are recorded. All hand transcribed entries include the quantity received, frequency of dose, date and staff signature. This entry should be checked and signed by a second staff member. Risk assessments must be completed in relation to service users wishing to self medicate. 23/02/07 • 3. OP26 13 (3) In order to reduce the risk of cross infection, tablets of soap must not be available in communal bathrooms and toilets, and foot operated flip top bins must be provided with bathrooms, toilets and en suites. 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. Refer to Standard OP9 OP29 Good Practice Recommendations An opening or discard date should be recorded for prescribed external creams. Staff application forms should include a full employment history, so that any gaps in employment can be fully investigated. The Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Laurels DS0000043864.V318162.R02.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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