Inspection on 09/09/08 for TNP House

This inspection was carried out on 9th September 2008.

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

Other inspections for this house

TNP House 02/10/07

TNP House 06/12/05

TNP House 04/07/05

TNP House 25/10/04

TNP House 24/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE TNP House 15 Comberford Road Tamworth Staffordshire B79 8PB Lead Inspector Mandy Beck Key Unannounced Inspection 9th September 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address TNP House DS0000005029.V370523.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. TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service TNP House Address 15 Comberford Road Tamworth Staffordshire B79 8PB 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) 01827 316177 01827 68857 janine.owen@homecall.co.uk TNP Homecare (UK) Limited Janine Owen Care Home 12 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (12), of places Physical disability over 65 years of age (7) TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd October 2007 Brief Description of the Service: TNP is a family run residential care home that offers a home for 12 people over the age of 65. The Home is set in a large detached house with an extension at the rear. The property is located in a pleasant area of Tamworth and has a rear garden, which has recently been improved. There is adequate car parking space at the front of the Home. The Home has two lounges and a separate dining room. There are six single bedrooms and three shared bedrooms. Ensuite facilities are provided in five of the single rooms and in one of the shared rooms. There is a lift to the first floor. There are two assisted baths and a recently added an assisted shower. The fees charged depend upon the room and services needed for each person. The people using the service need to pay extra for chiropody, hairdressing, toiletries, alcohol, newspapers and luxury items such as sweets and chocolates. A small charge is made for transport costs and the hourly staff costs if they accompany a resident on visits, including hospital visits. People are asked to contact the home directly for this information. A copy of the most recent inspection report is available upon request from the home. TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. We looked at all the information that we have received, or asked for, since the last key inspection. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • Information we have about how the service has managed any complaints. • What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. • The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. • Relevant information from other organisations. • We also spent time talking to the people who use the service and to the staff who support them. We also looked at most of the home. • We looked at the care of three people who use this service in depth. This is part of our case tracking process and helps us makes judgements about the home’s abilities to meet people’s needs. What the service does well: People choosing to use this service have a chance to discuss their needs with the manager before they move in. Each person’s needs are assessed prior to admission this means that both parties can be sure that needs can be met. People have access the healthcare professionals when they need them. This should give people confidence their healthcare needs will be monitored and met. The home is small and friendly. It offers a relaxing place for people to live. We were told, “it is the most wonderful place to live”. The staff team at TNP House are consistent and in most cases have worked there for many years. People told us “the staff are wonderful”, “they never rush me, and when they help me I feel they are caring”. TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: People have their own individual care plans and risk assessments. The staff complete them but could be more person centred in their approach. This would reflect personal likes and wishes of the people living in the home. We looked at medication systems in the home and have recommended a few improvements to further safeguard those people living in the home. Staff need training to make sure their knowledge and skills are up to date. Training has taken place but it is now out of date and staff are in need of refresher courses. Some of the people we spoke to and who answered our questionnaire said “the home is cold, it could do with being warmer”. The manager has told us that she is trying to get the heating regulated for people but the current weather has proven difficult to judge. We made a requirement about staff recruitment during our last visit. We were unable to determine if the home has made improvements in this area because there have been no new employees since our last visit. This requirement will remain and we will continue to monitor the home’s progress through our inspection programme. TNP House DS0000005029.V370523.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. TNP House DS0000005029.V370523.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 TNP House DS0000005029.V370523.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): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service have told us they had enough information about it to make a choice about living here. People can also feel assured that their needs will be assessed in full prior to their moving in. EVIDENCE: We looked at the care needs assessment for three people who have recently moved into the home. In each case we saw that people had been consulted about their wishes and their needs. Where appropriate the manager had obtained a care manager’s assessment from the local authority. People we spoke to told us “the manager came to see me before I moved in, she talked to me about the things I wanted and what the staff would do for me”. Another person said, “I had to wait for a place here but I did come for a day or two to try it out”, “ I remember the staff asking about me and what care I needed”. This home does not offer intermediate care facilities. TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 10 TNP House DS0000005029.V370523.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have access to health care services both within the home and in the local community. People receiving services are happy with the care they are getting. EVIDENCE: We saw care plans and risk assessments for three people as part of our case tracking process. This process helps us to make judgments about the care that people living in this home are getting. We found that care records contain most of the information they need to meet people’s needs but improvements could be made. Risk assessments are completed by the staff that determine a person’s risk in relation to their mobility, moving and handling and nutritional well being. The information in the risk assessments should also be reflected in the care plans to make sure that there is natural flow to the care planning process. We saw that one person was at risk of dehydration, staff had recorded this in the progress reports but TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 12 there was no care plan that showed how they were going to reduce this risk for the person. They had also recorded that there was a need to monitor constipation on the nutritional risk assessment but there was no care plan that clearly showed how they were going to do this. It was however very clear when we spoke to staff that they had a very good understanding of this person’s needs and indeed the other people we case tracked. Staff are able to give detailed verbal updates of people’s needs, wishes and the way they like their care to be given. We spoke to people about the care they receive. They told us “the staff are wonderful and caring”, “they do know what I like and they talk to me about things”, “I never feel rushed when they are helping me”, “if I am ill or off colour they always ring the doctor for me”. All care plans and risk assessments are kept under review by the home manager, the reviews are recorded in each person care file. People said “yes they do talk to me to see if things are ok”. We also saw evidence that people have access to the healthcare they need. There are regular visits from the General Practitioner (GP), the district nurses and chiropodists, dentists and opticians. People should be aware that there may be an added charge for chiropody services. For those people who need pressure relieving equipment the district nurses complete risk assessments and also make sure that the appropriate equipment, such as pressure relieving mattresses and cushions are provided. Medication practices were also looked at. We found that some improvements had been made. The home is no longer practicing secondary dispensing whilst completing the medication round and the manager is keeping records of all medication that comes into the home. This will help her audit medication practices in future. We have made further recommendations to build upon current practice. We have said that staff should record the actual temperature of the fridge where medication is stored rather than currently recording “ok” on the log sheet. We have also asked the manager to obtain a minimum and maximum thermometer to make sure the fridge is maintaining safe temperatures and medication is stored as recommended. There were some eye drops needing cold storage in the kitchen fridge we have asked the home to obtain a locked box for these medicines to keep in the fridge. This will offer a further safeguard to people’s medication. We saw that staff are handwriting entries onto the Medication Administration Record (MAR) sheet, we have recommended that two staff sign these entries to reduce the risk of error occurring. The home does not have controlled drugs at present. Medication is stored in a locked trolley secured to the wall and incoming medication is stored safely in a locked filing cabinet. TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 13 The home manager completes staff training in safe handling of medicines. She has completed a trainer’s course in order to do this. We have recommended that all of those staff that administers medication have further training in this area. The manager told us that this would be arranged in the near future. People living here told us that staff treat them kindly and respect their wishes at all times. One person said that they would like to know the key code for the front door so they could get out and about. This was bought to the manager’s attention that said she would talk to the person about this. Another person said that staff “try to jolly us along and make sure we are happy”. Throughout the inspection staff were seen to be talking respectfully to people and were knocking doors before they entered people’s bedrooms. TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. The Home is flexible, welcomes visitors and provides a good healthy diet. However, some people feel that there are not enough activities at times. EVIDENCE: People we spoke to said that the home does try to do things to keep them busy. One person said “I would like to get out more but I don’t think there’s enough staff to do it”. Another said “I get a bit bored sometimes”. The manager told us in the Annual Quality Assurance Assessment (AQAA) that “people tell us that the geography of the home is a barrier to improvement and one lady asked the organist to stop playing as it gave her a headache. We have bought extra games for the few that want to join. We plan to “go along with what residents want to do””. The home has a lot of people living there that prefer to spend time in their own rooms and are enjoying their peace and quiet. TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 15 We saw during this visit that there is a steady flow of visitors throughout the day. There was a calm relaxing atmosphere through out the home and the people living here welcomed visitors. The manager told us “we have an open visiting policy, we like it to be friendly”. This was evident throughout the day. We saw some people’s bedrooms during this visit and it was pleasing to see that they have been encouraged to personalise their rooms with their own belongings. Since our last visit each person has had a lock put on their bedroom door so that they have the opportunity to lock their rooms when they wish to. Staff can override this lock in case of emergency however. Meals and mealtimes are planned around people’s needs. The home has two cooks who regularly talk with people to find out what they would like to see on the menus. All of the food is freshly prepared on the premises and alternatives are always on offer for those people who don’t want the main meal choice for that particular day. The cook demonstrated a good understanding of each persons dietary needs and requirements, offering blended meals and soft diets for those people who need them. People said, “the food is fab, always a choice and they always come to check to see if you liked it”. “My favourite is the cheese and potato pie especially with onions”. “I’d like to go out to the pub for a steak but the shepherd’s pie here makes up for that”. We have recommended that the manager introduce a food diary for those people who are at risk of malnutrition. This will give a clear reference of the food intake for people at such risk. TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. People using this service can be confident their views will be listened to and acted upon. Further staff training will increase staff knowledge of abuse and give extra safeguards to the people who live here. EVIDENCE: People in this home are able to make their view known. They said “if something wasn’t right I would talk to Janine”. “The manager is very good she’ll always help but then again so would all the other staff too”. The complaints procedure is given to people upon admission and is in the Service User Guide. There have been no complaints made to the service or to the Commission during the last twelve months. Safeguarding vulnerable adults training is now overdue for staff. Some staff have done some training as part of their National Vocational Qualifications (NVQ’s) but other’s haven’t done this. We have recommended this be arranged for all staff. The manager told us that this would be done as soon as she is given training dates from the Local Authority. TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 17 We made a requirement during our last inspection that all prospective staff must have appropriate safety checks in place before they commence employment, this must include a check against the Protection of Vulnerable Adults list (PoVA) and a Criminal Records Bureau disclosure (CRB). This was made to safeguard vulnerable people living in the home. Since our last visit no new staff have been employed but the manager was currently in the process of recruiting a new worker. We were able to see that the application form for these safety checks was almost completed and ready to be sent. We will carry out a random inspection in the near future to further assess this. TNP House DS0000005029.V370523.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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a pleasant and homely place. It is well maintained and clean. EVIDENCE: We have noticed improvements in the home since our last visit. The manager has now completed installation of all call bells in each bedroom. This means that people choosing to stay in their rooms have a way to alert staff if they need their assistance. We saw the airing cupboard in the bathroom on the first floor has now been converted into an assisted shower for people’s use. They said “I like it very much”. There is still some work to be done to the flooring in this room before it is completed but the manager told us this had been planned for. TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 19 The garden area to the rear of the home has been updated. A new patio has been laid and new furniture supplied for people to use and enjoy the garden. New grab rails and ramps have also been put into the garden to enable people to get about. Some people on the ground floor have direct access to the garden from their own bedrooms. Generally the home is pleasant and relaxing. The lounges are decorated nicely and have been personalised with people’s belongings. Some people did tell us they were cold and when we spoke to some people in their rooms we also noted that some of the rooms we visited were cold. This was discussed with the manager who did put the heating on, she also explained the heating was on a timer and given the recent bad weather this had proven difficult to regulate for people. She will keep the heating under review so that people are warm. The home has improved the storage of its cleaning products and they are now locked away in the laundry. The laundry, although small, is equipped to manage people’s washing. They said “we have a basket we fill each morning with dirty washing and then it comes straight back to us the next day, that’s good”. There have also been improvements in infection control practices with the introduction of liquid soaps in bathrooms and toilet areas for people to wash their hands with. Paper towels will also add to this practice and reduce the risk of cross infection to people. Staff training in infection control is out of date and staff will need refresher training to make sure their knowledge of current best practice is up to date. TNP House DS0000005029.V370523.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 adequate. This judgement has been made using available evidence including a visit to this service. People are supported by a staff group who understand their needs. More staff training will also improve staff knowledge. EVIDENCE: There are always two care staff on duty for each shift. This is in addition to the cook and the manager whose hours are usually supernumery. On this day the manager was counted into the care numbers because of a shortfall of staff. People said “they work very hard, they are very busy”, “I would like to go out but there aren’t enough staff to take me”. The manager keeps staffing levels under review. The number of staff who have completed their NVQ level 2 has not changed since the last inspection. There are currently eight out of twelve staff with this qualification. There have been no new staff employed since the last inspection. We were unable to check new recruitment files as a result. We will plan a random visit to the home to check this in the future. Staff training is out of date and needs to be addressed. The manager explained that she is waiting free training from the Local Authority for all of the TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 21 staff. This will include all mandatory training and some specialised subjects such as dementia, medication training and Mental Capacity Act 2005. We will also look at staff training during the random visit we are planning. TNP House DS0000005029.V370523.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): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is qualified and experienced to run the home. Health and safety practices generally protect the health, well being and welfare of the people living there but further staff training would improve upon this. EVIDENCE: The manager, Janine Owen, has the Registered Managers Award and National Vocational Qualification 4. She is considered to be very approachable by the staff and the residents and their families. The manager has a basic Quality Assurance system in place. She works with the staff, residents and relatives to ensure that all are happy with the service and addresses any concerns they may have. Questionnaires were sent to the TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 23 residents and/or their relatives in February 2007, although the results were not evaluated or available to interested parties. It was suggested that she also send surveys to staff and external people involved in the Home. No new surveys have been sent out to people since our last visit. The manager does plan to do this shortly. The manager also completed the AQAA and told us some of the information about the home we needed to know but some of the information was limited in its detail and needed to be expanded upon. The ways the home are planning to achieve improvements are briefly explained. The home does not manage people’s money for them. Each person is invoiced for their expenditure and they then pay their bills. People do however have a lockable facility in their bedrooms where they can keep valuables. Health and safety practices are being improved. The home now has a fire risk assessment in place and person emergency evacuation plans for each person. This will assist the emergency services in the event of fire. Safety records and maintenance certificates were seen for fire fighting equipment, passenger lift and the lifting equipment in the home. As we have previously mentioned the health and safety of the people living here will be further enhanced once staff have completed their planned mandatory training. TNP House DS0000005029.V370523.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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? yes 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 OP29 Regulation 19 Schedule 2 Requirement The manager must make sure that the required checks are made on prospective staff members before they are employed and obtain all of the elements listed in Schedule 2 of The Care Homes Regulations 2001. (previous timescale of 01/11/07, we were unable to re- assess this requirement at this visit as no new staff have been employed) Staff need to attend training in fire safety, first aid, moving and handling and infection control. Current training files show that training is out of date and in need of updating. This will provide added safeguards for people using this service. Timescale for action 09/09/08 2 OP38 18 (1) 30/12/08 TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 26 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 Refer to Standard OP1 Good Practice Recommendations It is recommended that more specific detail be included in the information about fees and costs to the people using the service to demonstrate openness and transparency. In this case this pertains to possible transport and staff costs for residents attending appointments. The care plan information should be expanded to make sure that the staff know the assistance required to meet the needs of the people using the service. The home needs to record the actual temperature of the fridge where medication is stored. They should also obtain a min/max thermometer for this purpose. Those medicine requiring cold storage should be kept in a locked container inside the domestic fridge. Where are variable dose is recorded, such as one or two tablets, the home should record how many they have administered. Two staff should sign the MAR sheet when handwritten entries are made. This should reduce the margin for error and safeguard people. Staff should have further training in Safe handling of medication. This will provide further safeguards for people living here. For those people who are nutritionally at risk we recommend the service keeps a food diary so that they can monitor how much people are eating. All staff should either attend refresher training or training in safeguarding vulnerable adults. This will make sure that staff have the knowledge needed to recognise and respond to adult abuse. The home should be warm enough at all times to meet people’s needs. The manager should explore how the Quality Assurance system could be improved to involve the views of more people involved in the service, for example staff and professionals. The results of any surveys should be available to interested parties. Staff need to have regular supervision with a senior DS0000005029.V370523.R02.S.doc Version 5.2 Page 27 2 OP7 3 4 5 6 7 8 9 OP9 OP9 OP9 OP9 OP9 OP15 OP18 10 11 OP19 OP33 12 OP36 TNP House member of staff, records of each supervision should be kept on their personal file. TNP House DS0000005029.V370523.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 TNP House DS0000005029.V370523.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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