Inspection on 28/04/05 for The Meadows

This inspection was carried out on 28th April 2005.

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

The inspector 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 Meadows 26/06/07

The Meadows 04/04/06

The Meadows 13/10/05

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE The Meadows Britwell Road Didcot Oxfordshire OX11 7JN Lead Inspector Delia Styles Unannounced 28 April 2005 09:50 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 Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Meadows Address Britwell Road, Didcot, Oxfordshire, OX11 7JN 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) 01235 518440 01235 518469 manager.themeadows@osjctoxon.co.uk The Orders of St John Care Trust Sheena Cunnington Care Home with nursing (N) 68 Category(ies) of Dementia DE(E), over 65 years of age - 7 registration, with number Mental disorder, excluding learning disability or of places dementia (MD) - 8 Physical disability (PD) - 45 Terminally ill (TI) - 5 Old Age, not falling within any other category (OP) - 68 The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Condition 1. The maximum number of service users accommodated at any one time must not exceed 68. Condition 2. The maximum number of places that can be used to accommodate service users with nursing needs must not exceed 38. Condition 3. The categories DE, MD and LD apply only to those original residents transferred from Ladygrove House to the new home in October 2004. Where proposed new admissions to the home do not come within the categories of service provided, The Orders of St John Care Trust must apply for a Variation of Registration. Date of last inspection NA Brief Description of the Service: The Meadows is a new purpose built care home completed in October 2004 and situated on the site of the original Ladygrove House care home in Didcot. Didcot is an expanding town, approximately 12 miles south of Oxford, with a good mainline rail service to Oxford, Reading and London, and bus links to local towns such as Abingdon and Wallingford. The home is next to a school and the town Civic Centre. Local shops and a major new shopping precinct are nearby. The home has three floors with the accommodation for residents on the gound and first floors. All the floors are served by a lift and stairways. There are 68 single rooms for residents that all have an ensuite shower, toilet and handbasin. Each floor has spacious sitting and dining rooms and adapted toilets, bath and shower rooms for disabled residents. The ground floor also has a separate day care facility with its own entrance. There is a hairdressing salon, therapy room and shop just off the main reception area known as the Heart of the Home. The landscaped gardens have a central water feature, flower and herb beds, and planted arbours. The kitchen and laundry areas, staff rest rooms, reception and administration offices and the home managers office are on the ground floor to the right of the main entrance. The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that lasted 6 hours, and was carried out by two inspectors, Delia Styles and Kate Harrison. Delia Styles and Sandra Lemon, Regulation Manager had also made an unannounced early morning visit to the home on the 12th April 2005: this was as a result of a total of 6 complaints having been received by CSCI about the home over a period of 2 months. The inspectors’ judgements about both inspections have been included in this report. Both inspectors toured the premises and then one went to the ground floor – Bluebell wing – and the other to Poppy and Primrose wings on the first floor. Inspectors spoke to a total of twelve staff on duty, 25 of the 65 residents, and one visitor. Printed information about the Commission for Social Care Inspection (CSCI) was given to 2 residents. One resident completed and returned a questionnaire about The Meadows to CSCI after the inspection. What the service does well: What has improved since the last inspection? The home was registered in October 2004 and not required to have an inspection until 2005. The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 Page 6 What they could do better: The CSCI has received a total of 6 complaints alleging poor standards of care of residents and poor sharing of information between staff about the needs of residents, especially those admitted for short ‘respite’ care stays. These complaints were received over a period of two months – February and March 2005. The Orders of St John Care Trust have produced an action plan, with timescales showing how they intend to improve. At the time of the inspection there were too few staff to consistently meet the needs of residents. This was especially the case on the first floor wings providing nursing care. There must always be enough members of staff with the right skills and experience to provide the care needed by residents. The home must increase the numbers of staff by May 31st 2005. The arrangements for the induction, training and supervision of new care staff are unsatisfactory. All staff must have a planned period of initial training, covering basic health and safety topics; this should be completed within 6 weeks of their appointment. The home must ensure that all new staff have had adequate training and this must be achieved by May 31st 2005, and be ongoing, as and when new staff are appointed. The National Minimum Standards for Care Homes for Older People state that all staff should have a minimum of 6 sessions of formal supervision in a year. Supervision meetings give staff the opportunity to discuss their work and any training that they need, with a senior member of staff. The home does not have a system for making sure that all staff attend supervision meetings and that individual staff members and their supervisor have written records of meetings. At the time of the inspection, the manager, Sheena Cunnington, did not have a deputy and three of the qualified nurses were on extended probationary periods, meaning that they had to have additional support and supervision in their work. The home must ensure that staff working in the home are appropriately supervised, so that all staff have a clear understanding of their roles and responsibilities, by May 31st 2005. The records of recruitment and appointment of staff were not complete, when inspectors looked at a sample of staff records during the earlier inspection visit to the home made on April 12th 2005. Staff must be recruited correctly so that the home can show that residents are being cared for by suitably experienced and trained staff members. Records must be complete and kept in the home, by May 31st 2005. The assessment of resident’s care needs and written care plans should be improved so that staff are able to know what to do for each resident and can show that the care that is given is effective. The OSJCT has started a programme of training for nurses and care staff about how to write care plans, so that there will be better written instructions for staff to follow, and so that The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 Page 7 residents and their relatives can be involved in discussing and agreeing the care plans as much as possible. The system for ordering residents’ medicines should be improved so that the home does not over stock items that are not regularly needed or used by residents, as the stored medicines may go out of date for use and this is wasteful. Staff should improve the way in which they make hand-written alterations to residents’ printed medicine charts, when the doctor asks them to, by having a second member of staff check and sign the alteration. The doctor and pharmacist should be asked to prescribe and supply the most convenient form of a medicine, for example, a liquid rather than in a tablet, if residents have difficulty in swallowing. There should be better communication between staff and residents about what activities and planned social events are arranged in the home, so that as many residents who want to, and are able, can be invited to join in, and so that staff have enough time to help residents get ready for outings and activities. Where residents are assessed as needing equipment, for example, bed rails to be fitted to their beds at night to lessen the risk of them rolling, or falling out of bed, the home should provide the appropriate bed and rails. 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 Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 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 Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 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 Individual care needs assessments are carried out before admission to make sure that the home can meet the individual’s needs. EVIDENCE: The inspector saw the pre-admission needs assessments for three residents who had been at the home for a considerable time. All contained appropriate information from the care managers and the inspector understood that new pre-admission assessment forms have recently been introduced at the home. The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 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) 8 and 9 The health care needs of the residents are not always known or addressed, as the assessment and care planning arrangements at the home are not comprehensive. Overall, medication is well managed at the home. EVIDENCE: Three residents’ files were assessed on Bluebell wing. The moving and handling assessment was not completed for a resident needing help with bathing, and although the moving and handling assessment was completed for another resident, it was not dated or signed by the assessor. Assessments regarding risks of developing pressure wounds were not completed for some individuals, and in the case of one resident, where directions had been given for the care of a wound by a registered nurse, there was no care plan in place and the treatment had not been delivered. Nutritional assessments were not completed for most of the residents. The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 Page 11 As the home uses a weekly bathing rota it was not clear to the inspector that residents made the decision regarding the frequency of showering and bathing. The inspector was told that the home’s care planning procedures are being reviewed, so that each issue will be appropriately assessed and the action to be taken by care staff will be clearly recorded and implemented. On Bluebell wing the inspector checked the medication records for three individuals and found that the medication was appropriately recorded, including when individuals refused to take medication, and that the remaining medication agreed with the records. On Poppy wing, there were some gaps where staff had not signed the record to show that medication had been given or, if missed, the reason why. Records should be completed correctly to show that all prescribed medicines are given so that the residents’ treatment is not interrupted by missed doses. Some medication records were handwritten by a nurse, who had copied the instructions from the medicine containers brought in by residents admitted for short-stay ‘respite’ care. Ideally, staff should only handwrite medication instructions in an emergency. If staff hand-write instructions, these should be checked and signed by a second member of staff, as an additional safeguard from mistakes. The home’s staff should ask the individual’s medical practice to provide a list of their most recent medication, before they come in to the home. Some residents had their tablets crushed because they had difficulty swallowing. The nurse said that the doctor had been asked if it was all right to do this (some tablets should not be crushed because it affects the way the medicine works), but there was no entry on the medicine record to confirm this. The nurse said she would ask the pharmacist if there was a liquid form of the medicine that could be prescribed instead. There were a large number of individual’s medicines stored in the clinical room on Poppy because repeat orders for medicines are made by staff for residents’ tablets, though they may not have used up previous supplies. Over-stocking of medicines should be avoided because it is wasteful. Controlled drugs are appropriately managed, and all medication is appropriately stored. The recent pharmacy inspection of the home showed no areas of concern. The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 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) 12 The home appears to have no systematic way of matching residents’ recorded interests with the activities available, or of giving the residents some choice and control over the leisure activities at the home. EVIDENCE: The home employs an activities coordinator who works between the two floors. The inspector noted that the activities programme was posted on the notice board, but that the activity planned for the day - crafts- was not available to the residents. The residents were not informed that this had been cancelled, and seemed unaware that the activity had been planned. During the afternoon the inspector noticed the coordinator engaged with some residents using a large ball in the entrance area. The inspector understood that an outing had been planned for a small number of residents but that this was cancelled on the day, due to the transport not being available. The inspector noted that one resident’s interests were recorded, but that the information was not used in a meaningful way. The residents spent most of the day sitting in the chairs arranged around the sitting room walls. Staff told the inspector that they would like to spend some time talking to the residents, or time engaging in activities with them, but that they did not have enough time. The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 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) These 3 Standards were not assessed during the inspections in April, but will be looked at in future inspection(s) EVIDENCE: The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 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) 25 and 26 The standard of the environment within this home is good providing service users with an attractive, clean and spacious place to live. EVIDENCE: The home was commendably clean throughout. Residents spoken to were very complimentary about the home’s facilities and their own rooms – “it’s like living in a four-star hotel!” The laundry was well organised and tidy with good systems in place. There were supplies of disposable gloves and plastic aprons for staff to wear and good hand washing facilities, The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 and 30 There are too few staff to consistently meet the needs of residents. The records of staff recruitment are incomplete and do not provide evidence that the home’s recruitment and training policies provide safeguards to offer protection to people living and working in the home. EVIDENCE: Two residents on the first floor told the inspector that the staff were always busy and had too little time to talk with them: ‘some talk, some don’t’; ‘people just walk past the door’ There was one registered nurse and 4 care assistants working on Poppy wing, looking after 23 residents, and one nurse and 2 care assistants caring for 17 residents on Primrose wing. On the ground floor there was one senior carer and 2 care staff looking after 25 residents. One care assistant was called away to attend an NVQ pre-training session during the morning, so that a care assistant, who was unfamiliar with the residents on Primrose wing, was sent there to help the registered nurse. The minimum total number of care staff to be provided to care for residents, as agreed with the CSCI when the home was registered, were on duty on the day of inspection. However, in addition to personal care of residents, the care staff are also responsible for laying tables and serving meals and drinks for residents during the day. Residents on Primrose wing had not had a mid-morning drink because the two staff were too busy, so residents had not had a drink since breakfast time at about 8 am. Five residents were in the sitting room on Primrose wing before lunch (served at 12.30); one asked the inspector for a drink of water because they were thirsty. Another resident said that there was no way of ringing the bell for help The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 Page 16 - there is a call bell on the wall, but none of the residents in the room were able to get to the bell without someone’s help. A member of staff said how frustrated they felt that they could not provide the standard of care to residents they wanted to because they were too busy. The staff themselves had not had time to have a mid-morning break and had been on duty since 7 am. Staff told the inspector this was not exceptional – working on the first floor was always considered ‘heavy’ by staff allocated there. When a Regulation manager and inspector looked at a sample of 5 current staff members’ files, during their visit to the home on April 12th, they found that they were incomplete. Four out of five care staff on duty on Primrose wing during the morning and afternoon of the inspection, who had been recruited and who had worked in the home since 2005, told the inspector that they had not had any formal training in moving and handling residents or in fire safety procedures. They had worked with other more experienced care staff for several shifts, however, and had been instructed that they must always work with another staff member (until they had had training) when using hoist equipment to lift residents. Qualified nurses and care assistants who had been recruited before the home opened in October 2004, had had a week of training in a range of health and safety topics. One carer said that s/he was due to go on an induction course held at an external training centre, some time in May 2005, though it was understood by the staff member that this was for all new OSJCT employees, not specifically for care staff. The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 36 and 38 The arrangements for the formal supervision of staff are not in place. There were not enough beds to which bed rails could be fitted to protect vulnerable service users from falling out of bed. The call bell system is intrusive, inefficient and causes delays in staff responses. EVIDENCE: Care staff said they had not had formal supervision with senior staff and there were no records of supervision on file in the staff records viewed at the earlier inspection. A record of probationary period interviews (undertaken at the end of the probationary 3 month period for new staff) was seen in relation to five staff. It is an expectation, and an indicator of good employment practice, for staff to have regular allocated individual time to discuss their work, progress, and any training needs, with a senior staff member at least 6 times a year, and for written records to be held by the staff member and their supervisor. The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 Page 18 Inspectors were informed by staff that of the 38 rooms available for residents who need nursing care on the first floor, only 17 beds were of the type that could have bed rails fitted. Some residents were assessed as being at risk of falling out of bed, and needed these protective rails. One resident’s care plan had entries that specifically referred to them being at risk and needing bed rails in place at night, but this equipment had not been provided. The inspector noticed that a resident’s call bell had been ringing for more than 3 minutes before it was answered. Staff have to walk some distance along each corridor or to the staff station to look at the call bell indicator panels on the wall to find out the room number of the resident who is ringing. All the calls for both floors show on the first floor panels and staff have to check the panel to see where a bell is ringing, even though it may not be on the wing or floor of the building where they are working. A staff member said that the bell sounder is muted at night to reduce the disruption to residents’ rest. Staff did not have a pager that they could carry, that would enable them immediately to check the room number and which resident was ringing for assistance, and reduce the number of times they had to check the display panels in the corridors. The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 1 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x 1 x 2 The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 Page 20 NA 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. 2. 3. 4. Standard 27 30 36 29 Regulation 18 (1) 19(5)9(b) 18(2) 19 & Schedule 2 Requirement There must be sufficient numbers of staff to meet service users needs. All newly appointed staff must receive adequate induction training. All saff must receive adequate supervision. Staff records must be complete and kept in the care home. Timescale for action May 31st 2005 and ongoing May 31st 2005 and ongoing May 31st 2005 and ongoing May 31st 2005 and ongoing 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 7 8 Good Practice Recommendations Continue to review and update service users care records as set out in the action plan already submitted to CSCI. 1. The registered manager should make sure that any action recommended by a health professional must be implemented in a timely way. 2. The home’s admission procedures should include timely assessments of an individual’s health and safety risks. 3. Nutritional screening for all individuals admitted to the home should be carried out soon after admission. H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 Page 21 The Meadows 3. 9 4. 12 5. 6. 38 38 4. Individuals preferences about the frequency of bathing or showering should be recorded at admission. 1. Staff should rarely need to make handwritten lists of residents medicines and administration instructions. If this is necessary, a second staff member should check and counter-sign the first persons entries on the Medicine Administration Record (MAR) sheet. 2. The local GP surgery should be requested to provide a list of a prospective residents most recent presribed medication, where the person is being admitted for shortstay respite care, before their admission. 3. Staff should always initial the MAR sheet at the time of administration of individuals medicine and and/or enter the appropriate code to show the reason why a prescribed dose has been omitted, if this is the case. 4. Repeat orders for medication should be monitored, so that there is no overstocking of medicines. 5. Staff should ask the doctor and pharmacist to review residents medication to make sure the most appropriate preparation of the medicine is prescribed and supplied. Residents interests should be recorded and they should have opportunities for stimulation through leisure and recreational activities. Up to date information about activities should be circulated to all service users and staff should be aware of any changes to planned programmes. Amend the call bell system so that bells sound on the individual wings/floors and supply pagers to staff. When resident(s) have been assessed, and a risk identified e.g need for bed rails, and where resident(s) and their relatives/representative agree, suitable beds and bed rails should be provided. The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Burgner House, 4630 Kingsgate, Cascade Way, Oxford Business Park South, Cowley, Oxford. OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Meadows H57-H08 S62306 The Meadows V224714 280405 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!