Inspection on 21/08/07 for Westholme

This inspection was carried out on 21st August 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Westholme 03/10/06

Westholme 20/12/05

Westholme 25/05/05

Westholme 01/02/05

Westholme 27/07/04

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Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Westholme Thornhill Road Upper Wortley Leeds LS12 4LL Lead Inspector Ann Stoner Key Unannounced Inspection 21st August 2007 09:45 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 Westholme DS0000033302.V348445.R01.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. Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westholme Address Thornhill Road Upper Wortley Leeds LS12 4LL 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) 0113 2638203 0113 2638203 Leeds City Council Department of Social Services Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (39), Physical disability (1) of places Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No service user under the age of 50 years is eligible for the PD placement 3rd October 2006. Date of last inspection Brief Description of the Service: Westholme is a local authority home providing personal care without nursing for up to 40 older people. The home is situated in Wortley a suburb of Leeds and is near local facilities such as shops, pubs and a small park. Public transport is nearby and Armley Town Street is within 10 minutes walking distance of the home. Accommodation is provided in single rooms over two floors, with a passenger lift proving access to the second floor. There are small communal areas on both floors, the main dining room is on the ground floor, but a small additional dining room is available on the first floor. One of the lounges on the ground floor is designated as a smoking area. There are attractive gardens surrounding the home and there is a small car park at the front. The current scales of charges at the home range from £10. 56 per night to £458. 85 per week. More up to date information about fees can be obtained from the home. Copies of previous inspection reports are available in the home. Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was unannounced and was carried out by one inspector who was at the home from 9.45am to 6.30pm on the 21st August 2007. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people living there. Before the inspection evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the visit. Survey forms were sent out to people living at the home, their relatives and health care professionals. Information from returned survey forms is reflected in this report. An AQAA (Annual Quality Assurance Assessment) was completed by the home before the visit to provide additional information. During the visit a number of documents were looked at and all areas of the home used by the people living there were visited. A good proportion of time was spent talking with the people who live at the home and their relatives, as well as with the manager and staff. Feedback at the end of the visit was given to the manager. I would like to thank everyone who contributed to the inspection process and to the home for the hospitality throughout the day. What the service does well: There are many positives about this home but the most significant are around the rights and choices of people living there. Throughout the inspection staff were kind and patient when working with people living at the home and never rushed anyone. There is a strong emphasis on respecting people’s choices and people are asked and consulted about their views and opinions before any changes in the home are made. This is good practice. There are regular meetings for people living at the home and it is clear that people feel they are ‘listened to’. Comments in returned survey forms from people living at the home included the following: • • • • • “I couldn’t be in a better place.” “I feel the staff are here all the time if I need them.” “I am very happy at Westholme.” “The staff are excellent they do actually care.” “The home is very clean, I cannot fault it.” DS0000033302.V348445.R01.S.doc Version 5.2 Page 6 Westholme A comment in a returned survey form from a GP (General Practitioner) said the home does well at providing ‘client focussed care, looking at individual needs’. Staff work as a team and feel valued by the management team. What has improved since the last inspection? What they could do better: The main area for improvement is around care plans and other care records. This has affected the home’s overall quality rating. If there is a significant improvement in these records at the next key inspection the overall quality rating for the home will increase. People living at the home must have a detailed care plan that gives staff clear instructions on how care should be given in all aspects of the person’s life. This will make sure that people receive care that meets their individual needs. People living at the home should have accurate information about the cost of their stay at the point of admission. This should help to alleviate any worries about whether the person can afford to stay at the home. A nutritional and falls risk assessment should be carried out for everyone on admission and at a later date if necessary. This will make sure that those people at risk are identified and preventative action can be taken. A metal perimeter fence must be erected as soon as possible to make sure that people are safe. Water-soluble bags must be used when laundering soiled linen. This will reduce the risk of cross infection in the home. Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 7 Staffing levels must be reviewed to make sure that there are enough staff on duty at all times. This will make sure that people’s needs are met at all times and in all areas of their life. Some minor amendments are needed to medication recording and holding of keys. This will prevent unauthorised access to medication and reduce the risk of mistakes. 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. Westholme DS0000033302.V348445.R01.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 Westholme DS0000033302.V348445.R01.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): Standards 1, 2 & 3. Standard 6 does not apply to this home. People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People living at the home are not always involved and consulted during the admission process and are not always aware of the cost of their stay at the point of admission. This limits their choice. EVIDENCE: There is a wide range of information available in the front entrance of the home so that people, who currently live at the home as well as those who are thinking about moving into the home, are aware of what the home has to offer. This is also available in the form of an information pack in all bedrooms. The manager said that he is looking into ways of making this information more accessible, such as on audiotape. Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 10 The admission process of two people living at the home was sampled. When speaking to one person and from looking at his records it was clear that he was not consulted or had any choice in the admission process. Before his admission to the home this person was in hospital. He said that he was, ‘told to pack up’. He had no information where he was going, did not know the home, arrived by ambulance and for the first few days felt lost. Although he is now very happy in the home and full of praise for the staff and the care he receives he is anxious because he has now lived there for six weeks but has no idea about the cost of his stay. This is unacceptable and something the organisation should address. The manager said that he was clear that the home would not admit anyone whose needs cannot be met. He also said that when a referral for admission is made he takes into account the needs of the people already living at the home and the impact that the new admission may have on them. This is good practice. Westholme DS0000033302.V348445.R01.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): Standards 7, 8, 9 & 10. People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. The health care needs of people using the service are met but care plans do not provide full details of people’s needs. This means there is the potential for care needs to be overlooked. EVIDENCE: The care records of three people were looked at in detail. Two had respite care plans and one person who had a permanent place at the home had a lifestyle plan in place. Information on the respite care plans was scant and did not reflect the actual care that was being delivered. One person had been admitted because of self-neglect and depression. Staff had a good knowledge of this person’s needs and described the level of care and support given, but none of this was recorded. This person was able to wash and bathe independently but there was no plan or risk assessment in place. He was nutritionally in the ‘at risk’ category but there was no nutritional risk assessment in place and no information that staff should offer nutritious Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 12 snacks between meals. There was no social and leisure plan, no mental health plan and no plan for continence, despite him having a catheter on admission. Care staff described the care and support given to another person and the cook described how she enriched this person’s food with butter and cream to provide additional calories. Again none of this was in this person’s plan, there was no nutritional risk assessment, no falls risk assessment and no plan for the prevention of falls despite the person having a history of falling both before admission and whilst living at the home. The lifestyle plan had more information than the respite care plans. However, community nursing staff had ordered a pressure mattress for this person but there was no pressure area care plan in place. The manager was aware of these issues. He is a member of a working party for the organisation looking at developing a new format and style of care plans. In returned survey forms from people living at the home people said that they received the support they needed. One person made an additional comment saying, “With the care and support I get from staff and management I could not ask for more.” When asked in a survey form about what the home does well, one GP said, “Client focussed care looking at individual needs.” Staff had a good understanding of recognising changes in the health care needs of people who were unable to communicate. There was evidence in care records of people having access to GPs, optical, chiropody and dental services. Returned survey forms from GPs showed that people’s health care needs are met. One GP made an addition comment saying, “Requests for GP visits are appropriate and people appear to be well cared for.” Staff described the different ways that they protect the privacy and dignity of people living at the home and this was seen throughout the day. From minutes of staff meetings it is clear that these issues are discussed regularly. Both GPs who returned survey forms said that people’s privacy and dignity is respected. Medication was ordered, stored and administered properly. Two recommendations were made to reduce the risk of errors and misuse of medication. Keys to the medication trolley and cupboards were held on the home’s main bunch of keys and not held by the person in charge for the duration of the shift. Handwritten entries were made on Medication Administration Records (MAR) and had not been checked and countersigned by a second person. Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 13 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): Standards 12, 13, 14 & 15. People who use the service experience excellent quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. Wherever possible people living at the home are encouraged and supported to make choices and decisions. This means that they are in control of their lives. EVIDENCE: The manager is clearly committed to providing a care service that is based on empowering people living at the home and supporting them to make decisions and take control of their lives. From discussions with people living at the home it is evident that they are consulted and that regular meetings take place. When asked if people could voice their opinions freely, one person living at the home said, “Of course, it is ‘our’ meeting.” The main meal of the day is served at lunchtime. The manager is aware of the benefits of changing this to a snack at lunchtime and having the main meal at teatime, but minutes of meetings for people living at the home show that the majority are against this change. The manager has accepted their decision, which is reviewed at each meeting. The manager has good links with Age Concern and regularly requests support from their advocacy service so that there is an independent person supporting those people living at the home, who would otherwise have no form of Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 14 independent support. A review meeting, with an advocate took place during the day. Staff had a good understanding of the individual needs and choices of people living at the home. They spoke about the importance of promoting independence and gave examples of how this works in practice. They were also knowledgeable about the reasons why some people with dementia may become distressed and gave examples of how they support people during these times. At lunchtime a member of staff was patient with one person when encouraging him to make a choice of meal. In order to help this person make a decision she showed him two different meals, which resulted in him making a choice. Another worker saw that a person was restless and wanted to go outside. This person was unsteady on his feet, so the care worker left what she was doing and assisted him to walk outside. All of this is good practice. As a result of feedback from meetings for people living at the home more outings take place. These are repeated several times to reduce the feel of an ‘institutional outing’, which means that only a small group of people go. People living at the home said that they preferred this. The home operates a key worker system and people living at the home were able to name their key worker. One person said that his key worker had recently taken him to the Grand Theatre in Leeds. There is little information within care plans about peoples’ past interests and social and leisure care plans do not focus on the past and present interests of people. This is an area where the home should improve. The numbers of staff and the layout of the building make it difficult for staff to spend ‘one to one’ time with people on an individual basis at different times throughout the day. Additional staffing would address this. The home has entertainers visiting the home each month in 2007. Staff said that two people regularly go to Church on a Sunday morning, and a Roman Catholic priest visits to give communion. Staff had a good understanding of the need for people to retain cultural and family links. They described how they regularly support one person to telephone her family in Scotland. People living at the home spoke highly of the meals. A cooked breakfast is available and there is a choice at both the lunchtime and teatime meal. Snacks and drinks are available 24 hours a day. One person said that if she goes to bed early staff always bring a milky drink and a snack at suppertime to her room. The home has recently introduced themed meals such as Mexican, Chinese and Italian. People living at the home spoke with enthusiasm about these. Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 15 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): Standards 16 & 18. People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. There are procedures and systems in place for responding to complaints and keeping people safe. EVIDENCE: Information supplied in the Annual Quality Assurance Assessment (AQAA), completed by the manager before this inspection, shows that there have been three complaints in the last twelve months. Records of these complaints held in the home shows that these were investigated properly. Returned survey forms from people living at the home show that they know how to make a complaint, and during this inspection people said that they would complain if necessary. The home has policies and procedures in place relating to safeguarding people. Care and domestic staff were clear about how to respond to any suspicion or allegation of abuse and were able to describe the different types of abuse. Staff training on safeguarding adults is on-going. Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 16 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): Standards 19 & 26. People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. The environment needs updating so that it is suitable for the people that live there. EVIDENCE: The manager said that there are plans to refurbish the home, which will include upgrading bathrooms and toilets, decorating lounges, bedrooms and corridors and some minor structural work. The manager is looking at ways of helping people with some degree of memory loss orientate themselves within the home. On two occasions cars have crashed through a fence narrowly avoiding bedrooms on the ground floor. As a result there are plans to erect a metal perimeter fence. This must be given priority status to make sure that people remain safe. Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 17 Returned survey forms from people living at the home state that the home is always clean. During this visit the home was clean, tidy and there were no offensive odours. Care and domestic staff had a good understanding of infection control. There was liquid soap and disposable towels in all areas where clinical waste and bodily fluids are handled, but staff hand sluice soiled linen instead of using water-dispersible bags. This increases the risk of cross infection. The manager agreed to address this as soon as possible. Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 18 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): Standards 27, 28, 29 & 30. People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. Staff have the necessary skills and training to meet the needs of people living at the home but staffing levels are not appropriate for the numbers of people living at the home and the layout of the building. This means that at times people may be left unattended. EVIDENCE: Staffing levels are not always appropriate for the layout of the building and the number of people living there. The AQAA states that there are 6 people with dementia, 2 people with mental health needs, 6 people are doubly incontinent and 2 people who need the assistance of two staff to help with their care during the day and night. This means, particularly during the night when there are only two staff on duty, that there are times when people are left unattended. In addition given the current staffing levels during the day, the layout of the building and the position of lounges there are times when people are again left unattended. This was observed during the inspection. Recruitment files were not sampled because there have been no new staff recruited in the last 12 months due to redeployment from another home. The manager described the recruitment and selection process that makes sure people are safe and suitable to work with vulnerable adults. Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 19 The AQAA shows that in the last 12 months training for staff on dementia care and safeguarding adults has started and the percentage of staff holding a NVQ (National Vocational Qualification) has increased to 75 with a further 15 being assessed. An induction programme based on the Skills for Care Common Induction Standards is in place for all new staff. Staff said that they were pleased with the amount of training on offer and were able to explain how they have transferred theory from the dementia care course into everyday working practice. Throughout the day it was clear that staff are knowledgeable, skilled, enthusiastic and eager to learn. Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 20 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): Standards 31, 33, 35, 36 & 38. People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. The home is well managed and the interests and health and safety of people staying at the home are promoted and protected. EVIDENCE: The manager holds a temporary position and has been in post for 8 months. During this time he has made many changes to the home. He has a clear focus on what he wants to achieve and is driven by his passion for empowering people living at the home to remain in control of their lives. Where this is not possible he makes sure that there is someone to represent their best interests. Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 21 He has applied to the CSCI (Commission for Social Care Inspection) for registration. He is respected by people living at the home and by staff. There is a robust quality assurance system in place so that the home obtains feedback on the service that it provides, allowing the manager to develop an action plan for future development work. The manager is committed to seeking the views and opinions of people living in the home. Regular meetings take place and minutes are circulated to everyone living at the home and their relatives. Minutes are also recorded on audiotape to make sure that as many people as possible have a record of the meeting. This is good practice. Records of staff meetings show that issues such as religion, use of inappropriate language, culture and discrimination are all discussed. Again this is good practice. Some people hand in money to the home for safekeeping. Records are kept of all transactions. The manager and the senior staff team carry out regular checks of the money and the system is also subject to regular external audit. Staff confirmed that they receive regular supervision and spoke about the value of these sessions. The manager analyses all accidents so that any patterns or trends can be identified. The pre-inspection questionnaire shows that servicing and maintenance of equipment takes place as required. Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 22 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 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) Requirement People living at the home must have a detailed care plan that gives staff clear instructions on how to deliver care. This will make sure that people receive care that meets their individual needs. Water-soluble bags must be used when laundering soiled linen. Timescale for action 30/11/07 3 OP26 13 (3) 30/09/07 4 OP27 18 (1) This will reduce the risk of cross infection in the home. Staffing levels must be reviewed 31/10/07 to make sure that there are enough staff on duty at all times. This will make sure that people’s needs in all areas of their life are met. Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 24 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 OP2 Good Practice Recommendations A contract of residency, that includes accurate information about fees, should be available to people at the point of admission. This will make sure that people are aware of the cost of their stay at the point of admission. Staff should complete nutritional and falls risk assessments when a person is admitted and later as necessary. This will make sure that those people at risk are identified and appropriate preventative action can be taken. Keys to the medication trolley should be separate from the home’s main bunch of keys. The person in charge should hold the medication keys for the duration of their shift. This will prevent unauthorised access to medication. Where handwritten entries are made on Medication Administration Records the entry should be checked and countersigned by a second person. This will reduce the risk of errors. The metal perimeter fence should be erected as soon as possible to make sure that people are safe. 2 OP7 3 OP9 4 OP19 Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Westholme DS0000033302.V348445.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!