Inspection on 16/05/06 for Weir Nursing Home The

This inspection was carried out on 16th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Weir Nursing Home The 16/12/08

Weir Nursing Home The 13/03/07

Weir Nursing Home The 31/10/05

Weir Nursing Home The 18/07/05

Weir Nursing Home The 12/10/04

Weir Nursing Home The 06/05/04

Weir Nursing Home The 09/02/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Weir Nursing Home The Swainshill Hereford Herefordshire HR4 7QF Lead Inspector Sandra J Bromige Unannounced Inspection 16th May 2006 09:40 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 Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 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. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Weir Nursing Home The Address Swainshill Hereford Herefordshire HR4 7QF 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) 01981 590229 01981 590445 Mrs Christine Juul Allen Mr David Anthony Kingham Care Home 35 Category(ies) of Dementia (35), Dementia - over 65 years of age registration, with number (35), Old age, not falling within any other of places category (35), Physical disability (35), Physical disability over 65 years of age (35) Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This Home provides care for residents aged 60 years and over. This Home provides specialist care for Parkinsons Disease sufferers. The Registered Provider shall carry out the requirements of the local authority, planning department, building control and environmental health (together called `the associated bodies`) in respect of the extension and until the associated bodies have indicated their satisfaction of due and satisfactory completion to the registered provider, it shall admit no more than 31 service users. The home may continue to admit service users with the categories DE and DE(E) provided that dementia is not of such severity as to render such service users either, as a danger to themselves or others. This service may accommodate a named service user with a physical disability between the ages of 55 and 60 years of age 31st October 2005 4. 5. Date of last inspection Brief Description of the Service: The Weir care home is situated in the village of Swainshill 4 miles from Hereford. The Georgian property is leased from the National Trust and managed by The Weir Nursing Home Ltd. It is set in attractive gardens adjacent to the Weir National Trust gardens with extensive views over the River Wye and surrounding countryside. It is a care home with nursing currently registered for a maximum of 35 service users of both sexes over the age of 60 years. Categories of care offered are physical disability; dementia and specialist care for Parkinson’s Disease sufferers. The Home was registered in 1995 and consists of a two and three-storey building. The Home has 22 single bedrooms, 15 have en-suite facilities. 5 double bedrooms of which one has an en-suite facility. The three bedded multiple occupancy room at the front of the building has recently been emptied and is being converted by the home’s maintenance staff into a further sitting room. There is a passenger lift to all floors of the Home. The home has a range of equipment available for moving and handling residents with physical disabilities. The current range of fees are £550 - £700 per week. Additional charges are made for hairdressing, chiropody, newspapers & periodicals & taxi fares. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit took place on the 16th May 2006 by two Inspectors over a period of 7.25 hrs. The purpose of this inspection was to assess the outcomes for residents against the key National Minimum Standards. Information to inform the inspection has been sought from many sources. The Commission gathers information from the date of the last inspection to inform the next inspection. This information comes from notifications that the home sends into the Commission, any concerns, complaints or allegations, written feedback from residents & relatives and a visit to the home. This visit found significant concerns relating to the care delivered to identified residents and their care records were not providing adequate information about the care needs of these residents. Concerns were also identified relating to the homes management of medication. Two immediate requirements were made at the time of the visit. A letter of serious concern was sent to the owners on the 17th May 2006. An unannounced Inspection took place on the 25th May 2006 by a CSCI Pharmaceutical Inspector follow up concerns about medicines found at the inspection on 16th May 2006. The inspection took place over six hours on a Thursday and examined some stocks and storage of medicines, some Medication Administration Record (MAR) charts and other records relating to medication. Some bedrooms were visited. There were discussions throughout the inspection with the care manager. On the 5th July an unannounced visit took place by two Inspectors over a period of 4.75 hrs. No noticeable improvement had taken place with regard to the care records for residents despite there being an immediate requirement made on the 16th May 2006. The day prior to the inspection the Commission received 2 complaints from visiting professionals to the home relating to the provision and management of a syringe driver for pain relief for an identified resident and the training and competency of the trained staff in the home in relation to the care and management of the syringe driver. These complaints were forwarded to the home to investigate. A number of requirements from the previous reports have not been met. These relate to risk assessments & care plans for residents who are at risk of wandering out of the building, consultation with residents’ about their care needs, the provision of recreational care and exercise, the recording of identified problems in care plans showing the action taken and outcome of care, the accurate recording of administration of medication, provision of bedroom door locks, recruitment practice, staff supervision and aspects of Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 6 health & safety training. Failure to meet these requirements may result in enforcement action being taken by the Commission. What the service does well: What has improved since the last inspection? Bedrail risk assessments are in place in the records seen on this occasion and consent is being obtained prior to use for the individual residents. Monthly stock checks of controlled drugs are being carried out, although they are not sufficiently thorough as issues were found during the Inspection visit. Medicines were seen being given to residents by the trained nurse conducting the medication round in accordance with medication procedures and guidance. A full time Activity Co-ordinator was employed by the home in February 2006. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 7 The environment has improved as the home no longer has any multiple occupancy bedrooms in use and more single and shared bedrooms now have en-suite facilities. Staff have received training in fire prevention. decanted into containers with handwritten labels. being wedged open. Chemicals are not being The laundry door was not The homes current certificate of registration was prominently displayed in the home. What they could do better: Risk assessments must be included in the individual residents care plan where a resident is confused and is at risk of or has wandered out of the building onto the main road outside the home. Risk assessments must fully identify the factors associated with risk reduction/elimination for individual residents and the outcome of the risk assessments must be linked to the persons care plan, so that staff are aware of the risk to the resident and the care that is required to protect them from harm. The manager and trained staff in the home must develop and implement care plans for all residents based on the individual needs of the residents. The care plans must clearly explain in writing the care objective, the care problem/need and detailed action that is necessary to be taken by the staff at the home to achieve the outcome/objective stated. The care plans must be written & reviewed in discussion and agreement with the resident and/or their next of kin, where practicable. When new problems are identified for an individual resident they must be included in the care plan. The social and psychological care needs of the resident must also be assessed and written plans of care recorded so that staff know what they need to do for the residents to enable them to provide the care that is needed in order to meet residents individual health & social care needs. The manager/owners must ensure that they have safe systems in place to ensure that residents received prescribed medication in accordance with the prescriber’s instructions. The medicine fridge temperature must be checked and the temperature recorded each day to ensure that it is within the accepted temperature range. If it is not within the excepted temperature range, action must be taken by the home. The Medication Administration Records must be accurately written to ensure that they contain the same instructions for administration as shown on the medicine label which has been prescribed by the Doctor. Written care plans must be used for medicines prescribed for ‘as required’. The home must review the current arrangements for managing creams, ointments and other external medicines to make sure they are safe. They must carry out weekly audit checks of medicines to make sure all residents receive their medicine correctly. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 8 Residents must be consulted about their individual social hobbies and interests and plans showing how the home will enable the residents to maintain these social activities. Residents must not be locked in their bedrooms at any time. Residents must be able to go out of the building into the grounds at times of their choice and not be restrained from doing so due to the operation of the lock on the front door of the building, which has been put in place due to an identified resident wandering out of the building onto the main road outside the home. Staff upon employment must receive training about the recognition and reporting of abuse and the Herefordshire local procedures for the Protection of Vulnerable Adults. There must be documentary evidence that this has taken place. The identified hole in the ceiling must be repaired. The owners must review the deficient areas of the premises internally & externally and a report showing the outcome and action plan must be submitted to the Commission. Residents must be able to access a call bell at all times to enable them to call for assistance. Bedroom door locks must be provided for all doors. Staff recruitment must be thorough for the protection of the residents. The manager must ensure that two written references are obtained for all staff, including a reference relating to their last period of employment. The manager must ensure that the references are authentic and obtain written verification of the reason why the employee ceased to work in that position. This information must be obtained prior to employment in the home. The owners must develop a system, which allows them to assess the standard of the service given by the Home. All care staff must have regular supervision and this information needs to be recorded. Staff must be sent for training to make sure that a first aider is in the Home at all times. All staff must be given training in moving & handling residents upon employment and updated each year. Recommendations have also been made relating to the management of medication in the home. The home should review the design of the Medication Administration Records, obtain written confirmation of anticoagulant doses by proper use of the standard yellow anticoagulant record book, arrange & check and keep copies of the original doctors’ prescription forms (FP10) and write the Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 9 date on the label of all creams/ointments and other external preparations when first opened and to use within the accepted good practice expiry date. 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. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 10 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 Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 1, 2 & 3 Quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to the service. People who use this service have satisfactory information about the home in order to make an informed decision about whether the service is right for them. The home manager carries out a pre-admission assessment to ensure that the home is able to meet the residents care needs. EVIDENCE: Relatives of a resident spoken with said that they had visited the home on behalf of the resident and were given a choice of room. They have received a contract from the owners with the terms & conditions of residence. A resident who had recently moved into the home told the Inspector that the family had visited the home prior to the resident moving in. Written feedback from 4 residents state “my daughter made all the decisions. I didn’t really know I was coming here”, “ I visited several homes before the decision was made”, “my son visited several homes and chose this one”. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 12 Three residents stated in the written feedback that they did not know if they had a contract & one said that their “son dealt with it all”. Written feedback from a relative states that the manager visited the prospective resident at her home prior to admission and they have received a contract. Discussion with a relative of a prospective resident told the Inspector that they visited the home and had received a copy of the homes Statement of Purpose, but this did not contain any information relating to terms & conditions of residence and the homes management of the ‘free nursing care’ payments. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The standard of care records within the home is poor. Records are not sufficiently detailed to ensure that individual residents’ needs are met in a consistent manner, neither are they effectively reviewed to ascertain the effectiveness of the prescribed care. The lack of written information within the care plans relating to identifying, planning & delivery of care means that all residents cannot be sure that their health & personal care needs will be fully met. Most medicines are stored safely but arrangements for some external medicines need reviewing so as to be safe for all residents. Recording systems are in place but a sample of records indicated medicines are not always given to residents correctly or the records are inaccurate. This could put at risk the health and well being of some people who use the service. The privacy and dignity of residents is not being maintained for all residents at all times. EVIDENCE: Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 14 A random selection of six care files was examined (representing a 20 sample). Each care file contained a range of documents including some risk assessments. Several risk assessments failed to effectively apply the principles of risk assessment. For example, falls risk assessments failed to identify factors associated with risk reduction/elimination. Risk assessments used also failed to effectively link-in with subsequent care plans. For example, one person’s nutritional risk assessment classified the person as being at “high risk” (nutritionally), and stated “seek dietetic advice” within the outcome area. A clinically weak care plan had been developed under the heading “eating and drinking”, and failed to contain any reference to dietetic advice, nutritional supplements or even the nutritional and dietary preferences of the individual concerned, who experienced memory loss – which had not been incorporated within the care plan as an influencing factor. Some risk assessments contained inaccurate information. For example, one resident’s “Client Handling Risk Assessment” stated “76kg to 101kg (large frame)”. The maximum weight for the individual recorded on the resident’s weight chart was 70kg. Many care plans were standardised, pre-printed documents that fail to effectively address the needs of residents. Many care plans examined were extremely confusing and contradictory. For example, one person had a care plan for poor communication, within which, it had been stated that their “communication skills” were “good”, that their “main method of communication” was “verbal”, that their “speech” was “good”, “comprehension – understands spoken word” yet “****** communicates well though due to deafness and dementia does not always hear well and may misunderstand what is said”. This directly contradicts the view that communication is “good” “Reviews” had been undertaken since August 2005, and simply stated “No change”. A lot of data within care plans consist of tick boxes, and fail to communicate the exact care necessary to meet individuals’ needs. For example, one person’s care plan for “Getting up – Going to bed” stated “one carer required”, but failed to explain what the carer needed to do. The care plan failed to identify the exact need/s of the resident concerned, and failed to provide instruction to enable care staff to provide prescribed care in a consistent and unambiguous manner. Assessments failed to effectively generate plans of care when a potential need was highlighted. For example, one person’s admission assessment stated undiagnosed epilepsy. No plan of care had been written. The same person had “? TIAs” (Trans Ischaemic Attacks) recorded on their assessment. Again, no plan of care had been written. Care plans examined failed to comply with NMC (Nursing and Midwifery Council) guidelines relating to care records. Many care plans consisted of Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 15 simple statements rather than instructions. For example, one care plan for “Sleeping” contained observations such as “will drink in the night if awake”. The plan of care failed to identify the need, failed to identify a planned outcome and failed to describe what action was to be taken to achieve the specified outcome. Another care plan for “Hearing” related simply to a hearing aid, and failed to describe what communication and care practice was required to promote clear communication with the individual concerned. Some care plans contained what can be best described as scant information. For example, one person had a care plan for “Death and Dying”. The care plan failed to contain any information apart from the person’s date of birth, religion and next-of-kin. Another person’s plan of care relating to “Death and Dying” contained a section entitled “Consent for Active Intervention”. This contained the phrase “not known”. Care plans repeatedly failed to link-in with the medication prescribed for residents. For example, one person was being administered Haloperidol for behavioural problems. There was no plan of care for any behavioural problem. Daily care records were examined. The information contained within the daily records failed to generate plans of care, and failed to demonstrate due diligence by the home in response to acute changes in health care needs. One person’s records demonstrated concerns about the person experiencing possible Trans Ischaemic Attacks and vomiting. No plan of care had been written. Subsequent entries were as follows; “14/03/06…pale looking…ate small amounts…she needs to be observed”. The next entry was dated some eight days later, and read, “22/03/06…vomited at 03.15…pale and a little cold to touch”. No plan of care had been developed. The evidence presented indicates that staff and management within the home fail to understand the principles and importance of good record keeping, and fail to understand how poor record keeping can place vulnerable adults at risk of deficient care. Evidence available also confirms that management and nursing staff within the home are not using care records effectively, are not reviewing care records effectively and are not applying care in a robust and seamless manner. Many care plans were clinically deficient. For example, one person with dementia has an “Eating and Drinking” care plan on file. The document specified the need for “full assistance”, a “liquidised diet” and noted “swallowing poor”. It failed to recognise or address any choking risk, food preferences, the actual assistance required, the consistency of the food to be provided and failed to take into account the need for a specialist Speech and Language Therapy review/input/assessment. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 16 None of the care plans examined had been countersigned by, or agreed with the resident concerned or their representative. As a result of the concerns generated about care records on 16th May 2006, an immediate requirement was issued to improve care records. This was checked on the 5th July 2006. No noticeable improvement had taken place. A qualified nurse told the Inspector that they had only seen 4 care plans and had not written anything in them. This nurse had not received any induction relating to the care needs of the residents and was “picking up the needs from the other registered nurses or care staff”. On a visit to the home on 5th July 2006 the qualified nurse in charge told the Inspectors that they had “started work on the care plans and 2 were completed”. Comments within the 4 surveys from residents stated that they always or usually received the care and support they needed. A resident told the Inspector that the care received was “reasonable” and another resident said “they needed help with eating which they do not get”. The care plan for this resident does not state what assistance the resident requires with eating & drinking. If residents care needs are not clearly identified in the care plans, it is an indication that residents may not be given the care that they receive, which puts them at risk. Comments within surveys from 12 relatives stated that 10 were satisfied with the overall care provided. One relative stated that the resident and the relative were not happy with the care provided and provided a list of poor outcomes for this resident with regards to personal, physical & psychological care of this resident. Another relative stated that they were unhappy with the ‘mental’ care provided for the resident. Opportunity was taken to examine the home’s medication administration record (MAR) charts. The following issues of concern were noted; • • • • • MAR charts were handwritten – no counter-signing of entries to confirm accuracy. Medication had been crossed off MAR charts, with no identifying signature. The British National Formulary (a reference book for medication) was out of date (March 2005). One resident had been prescribed Diazepam and Tegretol Retard. No signature or code had been recorded on the MAR chart against the administration time of 22.00hrs on 09/05/06. One resident had been prescribed Co-Codamol 15mg/500mg to be given four times each day. The resident had only been given the medication twice on 15/05/06, and had routinely only been given the medication DS0000027692.V291571.R01.S.doc Version 5.1 Page 17 Weir Nursing Home The • • • • • • twice a day for the preceding week. There were no codes to identify any reason/s for non-administration. Another resident had been prescribed Ensure once a day but had not received it for the preceding 9 days. One resident had been prescribed “I Caps” (two twice a day). On Sunday 14/05/06, an entry on the MAR chart read, “No.5 not available”. Another resident had been prescribed Warfarin 1mg at´17.00hrs. This medication had not been given on 08/05/06 as “no warfarin” had been recorded on the MAR chart. One resident was prescribed Haloperidol 0.5mg once a day. The resident had not been given the medication between 08 and 12/05/06. The same person had also been prescribed Trimethoprin 100mg at 17.00hrs. This had not been given on 09, 10 and 11/05/06. One resident had been prescribed Calogen 30mls three times a day. The resident had not received it since 09.00hrs, 14/05/05, as the MAR chart contained an entry, “not available”. One resident had been prescribed Paracetamol (500mg – 1gram) on an “as necessary” basis. The resident had been regularly given Paracetamol five times a day, without any dose recorded on the MAR chart. A pre-printed document entitled “Prescription Sheet - “For the Safety of the Doctor” was examined, and contained “instructions”. Under section 6 of the document, it cites “Details of any administrations made on the authority of the Nurse in Charge without a prescription from the doctor should also be entered in the “Comments on Discrepancies” section”. The registered provider claimed that this was an instruction for “homely remedies” and not authorisation for nurses to prescribe. An immediate requirement was issued on 16th May 2006 for the safe management of medication. A pharmaceutical inspector subsequently examined medication on the 25th May 2006. Details of the pharmaceutical inspector’s findings are as follows; On the inspection day packs of medicines delivered from the surgery were in bags in the office rather than locked in the medicine cupboards. The recorded medicine fridge temperature was 0°C for 2 days at the beginning of May, which is too cold – other records, indicated the correct temperature. There are suitable arrangements to manage controlled drugs. There were discrepancies in some entries looked at in the record book and a few did not agree with what was recorded on Medication Administration Record (MAR) charts. There is a monthly stock balance check of controlled drugs recorded but it is not identifying these issues. There are arrangements to dispose of unwanted medicines as required by the Environmental Agency and relevant legislation. The recording system for medicines is complicated and difficult to follow at times. Some records were not complete. As the MAR charts are handwritten it is important these can be checked with the doctor’s original prescriptions (and Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 18 a copy kept) rather than copying from sheet to sheet as is current practice. With the medicines listed separately from the administration charts it is essential that these are carefully filed and can always be linked correctly without ambiguity. An alternative design of record should be considered to reduce this risk. An explanation is not always recorded if a medicine is not given. Some staff enter a code letter but this not explained. Some medicine charts did not have a signature or second check signature when rewritten and some did not have dates when rewritten. These are important checks to make sure the charts are accurate. The dates are important to link with the record charts of what medicines are given to residents. Completion of records when medicines are discontinued or changed is not always thorough – the date discontinued and person responsible is not always included. The box to enter information about allergies is not always filled in (good practice to use this even if ‘none known’.) To avoid possible confusion the medicine names on the MAR charts should be the same as the dispensing label provided by the pharmacy or surgery. There were examples where the new British Approved Names (BAN) are not used or a particular brand name is used, but the brand supplied may be different to when the chart was originally written. A number of medicines are prescribed ‘as required’ but what this means for that person is not described on the chart. Plans of the intended use of such medicines need to be available for all staff to refer to. Medicines are not always given according to the doctors’ directions contained on the records. For one resident directions indicate a regular use of two medicines but administration records do not show this. If the medicine is intended for use ‘as required’ this must be shown on the prescription. For another resident records for two antibiotic courses recently prescribed indicated that the resident did not have doses according to the prescription. Records for another resident similarly showed a strong painkiller was not always given twice a day as prescribed. In one example staff may have signed in the wrong time on the chart (a particular risk with this design of chart). 7am doses of a medicine for another resident are sometimes marked as ‘not available’ and not given by night staff although stock is apparently available. Day staff sometimes give the doses later when they come on duty and know the medicines are in stock. There are careful records for anticoagulant dose changes but these should be confirmed in writing by use of the standard yellow anticoagulant record book for example. A review of arrangements for creams, ointments and other external medicines is needed. Some items were seen unsecured in a bedroom, which could be a risk for some residents. There were no labels to indicate which resident, directions or date of opening. Staff were not aware of limited expiry date when in use - this is good practice to avoid cross infection risks. The insulin pen on the medicine trolley needed the resident’s name and date of opening. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 19 Most other medicine packs on the trolley had opening dates so audit checks are possible. The provider described an audit system he is introducing into the home which is to include medicines. This is urgently needed in order to investigate and correct the examples of poor recording or wrong medicine administration found”. Staff were observed knocking on doors and ensuring doors were closed whilst they were carrying out personal care to residents. Feedback from a relative of a resident reported that on a number of occasions they have observed staff talking over the resident when the resident was being helped to the toilet. This is evidence of a failure to observe the dignity of this particular resident. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 20 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 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. A range of activities are being provided as the home now employs a full time Activity Co-ordinator, although all residents social care needs are not being met and this is not evidenced in the individual care plans. Residents are able to keep in contact with their family and friends and there is evidence that they are able to make choices relating to care, although there is also evidence that all residents’ wishes are not being listened to and acted upon. Residents received a choice of a healthy and varied diet. EVIDENCE: A full time Activity Co-ordinator has been appointed & started work in the home in February 2006. A resident spoken with was not aware that the home employed anyone to provide activities, and chose to stay in their own room to read the newspaper and watch television. Another resident spoken with also chose to stay in their room watching television. A resident in a shared room told the Inspector that they would prefer to be in a room on their own and not have to share with another person. A resident told the Inspector that they preferred to use the toilet in their en-suite, but “some staff do not allow them the choice”. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 21 Care records for one resident contained a dated & timed entry which stated “in bedroom – room locked”. This is poor practice and is an unacceptable form of restraint of this resident. Comments in surveys from 4 residents stated that 3 residents were of the opinion that there are usually activities arranged by the home that they can take part in. One resident stated there are always activities provided, “but I don’t always want to take part, but join in most things”. Comments in surveys from relatives state that the home “have involved her in activities as far as she is able to take part (the limitation is with the resident, rather than the home). Written feedback from a relative stated that they were not satisfied with the ‘mental care’ of the resident and are of the opinion that “more effort could be made”, the relative was not aware until recently that there was an Activity Co-ordinator in the home, “I only found out because she came in whilst I was there!” Written feedback from another relative states “I feel the activities are very limited because there are very few people able to be involved in them”. 8 relatives made no comments about activities provided by the home. One comment card stated that the resident was withdrawn and as the nurses were from overseas “there is a language barrier therefore a communication problem”. A resident told the Inspector that they had “problems understanding staff”. The Inspector noted when speaking to one of the care staff from overseas that their English language was not very good, as she appeared to have difficulty understanding the questions being asked by the Inspector. The pre-inspection information provided by the manager states that the Activity Co-ordinator interacts with all the residents; plays cards, dominoes, arts & crafts, reading, singing and take residents out for walking & shopping etc. Comments in surveys from relatives all indicated that they were welcome in the home at any time and are able to visit the resident in private. “Staff are friendly and ready to help if asked, bring us visitors tea and cakes”. Please also refer to Section 5 (Environment) pertaining to residents’ choice to go outside into the gardens. All residents spoken with stated that they had a choice of meals each day. A copy of a two week menu provided by the manager shows that there is a choice of two main courses at lunchtime and a choice of soup and a main supper dish or sandwiches 6 evenings each week. Residents spoken with told the Inspector that the quality of the meals is “60:40”, “I like the food, but it is so difficult to eat them”, “food good”, “quite reasonable”. Comments in surveys from 4 residents say that 1 resident always likes the meals, 2 usually like the meals and 1 resident sometimes likes the meals. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 22 Written feedback from relatives has commented on the food provided by the home. “The food is excellent. It is ‘Home Cooking’. “The menu has choices and is chosen a day in advance”. Another relative commented that the resident had “lost a massive amount of weight, wasn’t eating much and received no inducement to tempt” the resident to eat, if the resident “didn’t like what was on the menu tough!!” A relative stated “there is a lack of fresh fruit but we take lots on our visits”. The 2-week menu seen is varied and appears to be nutritionally balanced. The home has two dining rooms and residents also eat in their bedrooms. A bowl of fresh fruit and jugs of squash were available in the lounge. Residents seen had drinks available in their bedrooms, although one resident who was in bed looked as if they would benefit from more to drink, as their mouth & lips appeared dry. There was no fluid chart in use in the room. The resident had 2 beakers of juice available, but it appeared that the resident relied on the staff to give them the drinks. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 23 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 the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Home has a satisfactory complaints system with some evidence that relatives and residents’ views are listened to and acted upon. Residents are at risk due to the poor management of the service, care documentation and the lack of provision & turnover of trained staff employed by the home. EVIDENCE: A complaints procedure is included in the homes Service User guide. No residents spoken with referred to this Service User guide when asked about how they would complain. Some residents said they would “tell the nurse and/or tell their family”. Comments in surveys from 4 residents asking if they know how to make a complaint responded; 2 residents said ‘usually’ and 2 residents said ‘sometimes’. Comments in surveys from 7 relatives all indicated that they were aware of the homes complaint procedure. Comments in surveys from 4 residents indicated that 3 residents said staff listened and acted on what they say and 1 resident answered only ‘sometimes’. Two residents when asked if they felt safe replied “yes”, “yes & no”. The homes complaints records contained information relating to 2 complaints that had been investigated by the home prior to the last inspection. There were no further complaints recorded since the last inspection. The complaints file also contained complimentary letters from 2003 to recent dates. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 24 The day prior to the inspection the Commission received 2 complaints from visiting professionals to the home relating to the provision and management of a syringe driver for pain relief for an identified resident and the training and competency of the trained staff in the home in relation to the care and management of the syringe driver. These complaints were forwarded to the home to investigate. Due to the findings during these visits to the home in relation to numbers of trained nurses recently left and the current provision of trained staff in the home, and that the care plans are not evidencing the needs of the residents, the Commission referred the service to Adult Protection using the local procedures for Protection of Vulnerable Adults. A decision was made by the Commissioners from the Primary Care Trust and County Council not to place any further residents in the home at this time. The owners were advised of the situation by the chairperson of the strategy group of multi-agencies. 5 staff files were seen and none contained any evidence that the staff had received any training in relation to the homes policies for protection of residents from abuse & whistle blowing, or any training on the types of abuse and recognition of abuse. A trained nurse spoken with was not aware of the homes whistle blowing policy or the local procedures for the Protection of Vulnerable Adults. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 25 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 the following standard(s): 19, 20, 21, 22, 23, 24 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recent investment has significantly improved the single and shared bedroom facilities in the home, although further refurbishment and redecoration is needed to keep the environment homely and safe for the people living and working in the home. EVIDENCE: All areas of the home seen during this visit were clean and there were no bad smells. Comments in surveys from 4 residents state that the home is ‘always’ or ‘usually’ fresh and clean. One resident commented that their “room is cleaned every day”. Parts of the home have been redecorated as they were altered as part of the new extension, although there is now some parts of the home such as existing toilets and bathrooms that need redecoration. There is a hole in the ceiling on Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 26 the middle floor that needs urgent repair, particularly in the event of a fire breaking out in the home. The gardens are pleasant and mostly lawn and are accessible to residents with assistance from staff, as the front door now has a coded lock on the inside due to a recent incident with a resident who wandered out of the building onto the main road outside the home. The Inspector was unable to get out of the front door without asking a carer for the code to the lock. Some residents may not have the co-ordination or manual dexterity to insert a code into the lock to enable them to go outside. The outside of the home is in need of repair and repainting as the old windows have bare wood exposed and paint flaking off the surfaces. Pre-inspection information provide by the manager indicates that the home was inspected by the Fire Officer in December 2005 and the Environmental Health Officer in August 2005, although it does not state if any requirements were made during these visits. The home has one sitting room, a small library and 2 dining areas. A further sitting room will be available when the conversion of the previous 3-bedded bedroom is complete. At the time of the inspection the residents had just been moved out of this bedroom and the owner said that the work is to be carried out by the homes maintenance person. There are toilets and bathrooms located throughout the building. Due to the new extension and conversion of the 5-bedded bedroom the home now has 15 single rooms and 1 double room with en-suite facilities. Adaptations are provided for residents with a physical disability throughout the home including the provision of a range of moving and lifting equipment. A call system is fitted throughout the home, although one resident who was in bed did not have any access to the call bell. A range of beds is provided by the home including divan and The new bedrooms have all been very nicely and tastefully beds are new ‘profile’ electrically operated nursing beds. locks have been fitted to the new rooms, although there existing bedrooms that do not have appropriate door locks. provide door locks has been required in previous reports. height adjustable. furnished and the Appropriate door are many of the A requirement to Records were seen of recorded monthly hot and cold water temperature checks, but there was no signature showing the person who carried out these checks. There were records showing that water samples have been taken as part of the homes management & prevention of Legionella. The owner reported that the homes risk assessment for Legionella was not available for inspection as it was with a member of staff who was away on annual leave. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 27 The laundry room was well organised and procedures for the prevention of cross infection are good. Residents’ clothes are nicely laundered by the staff in the home. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 28 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a high turnover of trained staff in the home and there are not sufficient permanent registered nurses employed by the home, which results in residents receiving an inconsistent and unsatisfactory service and places residents at risk. A programme of staff training is provided to ensure that new and existing staff have the skills to provide the care needed by the people living in the Home. Recruitment practice continues to improve but is still insufficiently thorough to ensure that staff appointed are suitable to work with vulnerable people. EVIDENCE: Comments in surveys from 11 out of 12 relatives report that they are of the opinion that there are sufficient numbers of staff on duty. Comments in surveys from 4 residents report that there are ‘always’ or ‘usually’ staff available when they need them. The manager was not on the premises at the start of both of the visits to the home. On the morning of the 16th May 2006 there were 2 qualified staff (1 was on induction & supernumery) and 4 care staff. Staff spoken with confirmed that they were short staffed that morning, as 2 care staff were not working due to sickness. On the morning of the 5th July 2006 there was a qualified nurse and 6 care staff on duty. The manager was due to come on Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 29 duty on the late shift as the nurse in charge, although she arrived in the office 25 minutes after the commencement of the inspection. Pre-inspection information provided by the manager prior to the inspection visit shows that 4 registered nurses had left employment at the home between 31st October 2005 & 27th April 2006. On the morning of the second visit to the home the nurse in charge told the Inspectors that the manager and herself were currently working ‘on the floor’ as they have had registered nurses leave employment at the home. From analysis of current staff rotas provided by the home and the list of staff employed by the home on 27th April 2006, it provides evidence of a high turnover of staff, particularly trained staff as a further 7 registered nurses have left employment at the home since 27th April 2006. Please refer to standard 18 of this report. There is currently a high usage of bank and agency trained staff in the home. Staff rotas show that the home employs 9 ancillary staff to provide catering and domestic support in the home. In addition the home employs a full time personnel manager/training co-ordinator and a full time activity co-ordinator. Pre-inspection information provided by the manager prior to the inspection indicates that 7 care staff have NVQ 2 or an equivalent qualification. Staff reported that 1 carer has NVQ 2 and 1 staff member has NVQ 4 and also has achieved the registered managers award. 5 staff recruitment files were inspected. The records for recently appointed staff showed that staff are not starting work until a PoVAfirst check has been received. Evidence was seen of Criminal Records Bureau checks for all staff employed at the Home. There was no evidence of an employment reference for one person and a testimonial reference had been accepted for another person. There was no information to show that the authenticity of the ‘To whom it may concern’ testimonial had been checked and there was no information to show the Home had verified the reason why they had left their previous employment. There was no evidence to show that one person had been interviewed by the home. 2 staff had not got a signed contract of employment on their file. Information provided shows that the homes induction programme is in line with the ‘Skills for Care’ standards. The Inspector was told that the induction period for staff takes up to one week to complete and during that time the new member of staff is supernumery to the rest of the team. Staff will then move onto the Foundation Standards, which have been obtained by the home but have not been started. The Inspector was advised that the induction training is not up to date due to the amount of hours being worked by staff and they have not time whilst they are on duty. Staff are paid to attend training in the home. Pre-inspection information provided by the manager indicate that since the last inspection internal training has taken place in topics including; fire, TOPPS values, confidentiality & worker relationships, and moving & handling. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 30 External trainers have provided courses for staff including pressure ulcers, basic first aid, food hygiene, fire, reflexology, continence and catheter/sheath care & fitting. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 31 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not being managed properly and there is a weakness in the leadership, guidance and direction to staff to ensure residents receive consistent quality care. Staff are not all being appropriately supervised to ensure that the Homes policies, procedures are being put into practice for the care and safety of the residents’. Systems for the management of health & safety in the Home need to be improved to promote and safeguard the health, safety & welfare of the people living and working in the Home. EVIDENCE: Since the last inspection the Commission has approved the manager’s application for registration. Due to the serious shortfall of qualified nurses employed by the home, the manager is currently working 5-7 shifts each week giving and overseeing the direct care of the residents as the qualified person in Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 32 charge of the shift. This leaves little or no time for her to fulfil her role as the registered manager of the home. Discussion and written information from current and previous members of staff employed by the home indicate the management do not maintain a good and professional relationship with the staff employed by the home. Staff have told the Inspectors that they are not prepared to speak out as they are afraid of losing their jobs, “staff are not valued” and have indicated that in their opinion the home is going backwards. Supervision for care staff is undertaken by the training manager and recorded, although staff records show that not all staff have received supervision at all or not since March 2006. The manager confirmed that qualified staff are not receiving any supervision, including new staff after their initial induction period and exit interviews are not carried out when staff leave employment in the home. Discussion with staff and staff records show that not all staff have received moving and handling training upon commencement of employment or every twelve months. Some staff have undertaken basic First Aid training since the last inspection, but this is not of a sufficient level of training to be the designated First Aider in charge of each shift. Internal & external fire training has been provided for staff since the last inspection. The manager has provided a list of the most recent inspection/service visits relating to fire, gas & electrical systems and equipment in the home, although there is no indication if any requirements or repairs were identified during these visits. Weekly and monthly fire system checks are recorded. The owner stated that the Fire and Legionella risk assessment for the home was not available when requested by the Inspectors. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 33 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 3 3 3 3 2 3 3 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 1 X X X 1 1 2 Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 34 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 OP7 Regulation 13, 15 Requirement Risk assessments must be included in the care plan where a resident is confused and is at risk of wandering out of the premises. Timescale of 31/12/05 not met Risk assessments must fully identify the factors associated with risk reduction/elimination and outcomes of risk assessments must be linked with subsequent care plans. Care plans must be developed and reviewed in discussion with the resident and/or their next of kin, to ensure that they agree to the content. Timescale of 30/09/05 & 31/12/05 not met Timescale for action 06/06/06 2 OP7 13 31/08/06 3 OP7 15 31/08/06 4 OP7 5 OP7 12, 15, 16 Care plans need further development to show consultation with residents about how the social care needs of individual residents are being met. Timescale of 31/01/06 not met 15 Written information must be provided in the care plan when a DS0000027692.V291571.R01.S.doc 31/08/06 06/06/06 Weir Nursing Home The Version 5.1 Page 35 6 OP7 15 7 OP9 13 8 OP9 13, 17 9 OP9 13, 17 10 OP9 13, 17 problem is identified to clearly show all of the action taken by the Home and the outcome. Timescale of 31/12/05 not met Develop & implement care plans for all residents based on their identified need. Care plans must clearly explain the care objective, the care need and the actions necessary to achieve the outcome/objective. Immediate requirement made. Timescale of 06/06/06 not met Ensure that systems are in place to enable residents to receive their prescribed medication in accordance with the prescriber’s instructions; this is with particular reference to people who have been prescribed oral hypoglycaemics, warfarin and anti-psychotic medication such as Chlorpromazine. Immediate requirement made. The medicine fridge temperature must be checked and recorded on a daily basis to ensure that temperatures are maintained in the range 2-8°C, and appropriate action taken if the temperature is outside of this range. Brought forward amended. Medication Administration Records must be accurately written to ensure that they contain the same instructions for administration as shown on the label of the medication, which has been prescribed by the Doctor. Timescale of 30/11/05 not met. Administer medicines to residents according to the doctors’ instructions and keep all records of medicines given to DS0000027692.V291571.R01.S.doc 06/06/06 16/05/06 31/08/06 31/08/06 31/08/06 Weir Nursing Home The Version 5.1 Page 36 11 OP9 13 12 OP9 13 13 OP12 16 14 15 OP12 OP18 13 13 16 OP19 13 17 18 OP19 OP19 13, 23 23 19 20 OP22 OP24 16 12, 13 residents completely and accurately. Keep written plans for the use of medicines prescribed for use ‘as required’. Review arrangements for managing creams, ointments and other external medicines to make sure these are safe. Carry out weekly audit checks of medicines to make sure all residents receive their medicines correctly. The registered person, having regard to the needs of residents and in consultation, must provide recreation and exercise. Timescale of 30/09/05 & 31/01/06 not met. Residents must not be locked in their rooms. All staff employed must receive training about the recognition & reporting of abuse and the Herefordshire local procedures for the Protection of Vulnerable Adults. The registered person must ensure that all residents can access the outside of the building at times of their choice and not be restrained from doing so due to the operation of the lock on the front door of the building. The hole in the ceiling near to rooms 203 & 204 must be repaired. A review must be undertaken of the deficient areas of the premises internally & externally and a report showing the outcome and any action plan must be submitted to the Commission. Residents must be able to access a call bell at all times to call for assistance when needed. Bedroom door locks must be provided for all doors. DS0000027692.V291571.R01.S.doc 31/08/06 31/08/06 31/08/06 21/08/06 31/08/06 21/08/06 13/08/06 28/09/06 21/08/06 30/09/06 Page 37 Weir Nursing Home The Version 5.1 21 OP29 19 22 OP29 19 23 OP33 24 24 OP36 18 25 OP38 13 Timescale of 31/03/05 & 31/12/05 not met. The registered person must make sure that references received are authentic and that they have obtained written verification as to the reason why the applicant ceased to work in that position. Timescale of 31/12/05 not met Two written references, including a reference relating to the person’s last period of employment must be obtained prior to employment at the home. The Provider must develop a system to monitor and audit the quality of service delivered by the Home. Brought forward, not assessed on this occasion. New timescale given. The registered person must ensure that care staff receive formal supervision. Timescale of 28/02/05 & 31/01/06 not met. The registered person must ensure provision of a qualified first aider at all times. Timescale of 31/01/05 & 31/12/05 not met All staff must receive moving & handling training upon commencing employment at the Home and at annual intervals thereafter. Timescale of 31/12/05 not met 21/08/06 21/08/06 30/09/06 31/08/06 30/09/06 26 OP38 13 31/08/06 Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 38 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP9 OP9 OP9 OP9 Good Practice Recommendations Review the design of the MAR charts so that details of all the medicines, doses and records of administration are contained on one document. Obtain written confirmation of anticoagulant doses by proper use of the standard yellow anticoagulant record book. Arrange to check and keep copies of the original doctors’ prescription forms (FP10). Write the date on the label of all creams / ointments and other external use medicines when first opened and to use within accepted good practice expiry date. Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 39 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN 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 Weir Nursing Home The DS0000027692.V291571.R01.S.doc Version 5.1 Page 40 - 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. 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